Provider Demographics
NPI:1811109242
Name:MARITATO, MARIANA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:MARITATO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 ABRAHAM WAY APT 101
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-5280
Mailing Address - Country:US
Mailing Address - Phone:208-649-5036
Mailing Address - Fax:
Practice Address - Street 1:718 MAIN ST # 1A
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-3744
Practice Address - Country:US
Practice Address - Phone:208-649-5036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4459235Z00000X
IDSLP-2225235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist