Provider Demographics
NPI:1558463133
Name:ZINNECKER, MARYELLEN M (MA,CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:M
Last Name:ZINNECKER
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12095 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP4218235Z00000X
KY139122235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist