Provider Demographics
NPI:1801552641
Name:HALIK, MARISSA LYNN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LYNN
Last Name:HALIK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:LYNN
Other - Last Name:HALIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1086 VILLA LN
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-4328
Mailing Address - Country:US
Mailing Address - Phone:218-234-7706
Mailing Address - Fax:
Practice Address - Street 1:910 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3500
Practice Address - Country:US
Practice Address - Phone:218-234-7706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty