Provider Demographics
NPI:1720851223
Name:RICCIARDI, MARISA
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:RICCIARDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4307 OLDE CHARTED TRL
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-5362
Mailing Address - Country:US
Mailing Address - Phone:330-974-8850
Mailing Address - Fax:
Practice Address - Street 1:5277 CHILLICOTHE RD
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-4334
Practice Address - Country:US
Practice Address - Phone:440-557-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist