Provider Demographics
NPI:1427338292
Name:HUMMEL, MARISSA IRENE (MS SLP-CCC)
Entity type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:IRENE
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1006
Mailing Address - Country:US
Mailing Address - Phone:570-713-5089
Mailing Address - Fax:
Practice Address - Street 1:3700 VARTAN WAY
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9441
Practice Address - Country:US
Practice Address - Phone:717-671-7811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010517235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist