Provider Demographics
NPI:1396155750
Name:MARYANSKY, INGRID (MS CCC-SLP TSSLD)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:MARYANSKY
Suffix:
Gender:F
Credentials:MS CCC-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10236 64TH AVE
Mailing Address - Street 2:APT, 4C
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1547
Mailing Address - Country:US
Mailing Address - Phone:917-579-3161
Mailing Address - Fax:
Practice Address - Street 1:10236 64TH AVE
Practice Address - Street 2:APT, 4C
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1547
Practice Address - Country:US
Practice Address - Phone:917-579-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist