Provider Demographics
NPI:1104547736
Name:SILVA, MARISSA (MS CCC, SLP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:SILVA
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 1:120 BEACON LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7524
Mailing Address - Country:US
Mailing Address - Phone:559-901-8235
Mailing Address - Fax:
Practice Address - Street 1:1040 WILDWOOD CENTRE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8402
Practice Address - Country:US
Practice Address - Phone:803-567-3348
Practice Address - Fax:803-728-3044
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8178235Z00000X
CA37681235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist