Provider Demographics
NPI:1104484906
Name:MARINI, KELLY MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:MARINI
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 1:399 DEAUVILLE DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2902
Mailing Address - Country:US
Mailing Address - Phone:484-868-6973
Mailing Address - Fax:
Practice Address - Street 1:399 DEAUVILLE DR
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2902
Practice Address - Country:US
Practice Address - Phone:484-868-6973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL014471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist