Provider Demographics
NPI:1801150834
Name:MARINELLI, JACQUELINE (MS ED)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:MARINELLI
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11097
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85061-1097
Mailing Address - Country:US
Mailing Address - Phone:855-639-7500
Mailing Address - Fax:
Practice Address - Street 1:3300 W CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-3030
Practice Address - Country:US
Practice Address - Phone:602-639-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY995096174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist