Provider Demographics
NPI:1912353046
Name:MARYELLEN M. ZINNECKER, MA, CCC-SLP, L.L.C.
Entity Type:Organization
Organization Name:MARYELLEN M. ZINNECKER, MA, CCC-SLP, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYELLEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZINNECKER
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:513-702-3101
Mailing Address - Street 1:12095 STONE POINT CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-5420
Mailing Address - Country:US
Mailing Address - Phone:513-702-3101
Mailing Address - Fax:513-672-0704
Practice Address - Street 1:12095 STONE POINT CT
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-5420
Practice Address - Country:US
Practice Address - Phone:513-702-3101
Practice Address - Fax:513-672-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-07
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency