Provider Demographics
NPI:1811108871
Name:WISNIEWSKI, MARYANN (SLP)
Entity type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 PHEASANT RUN RD
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-1531
Mailing Address - Country:US
Mailing Address - Phone:508-432-7811
Mailing Address - Fax:
Practice Address - Street 1:80 DEACONESS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4113
Practice Address - Country:US
Practice Address - Phone:508-487-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2635235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist