Provider Demographics
NPI:1902462310
Name:MARCINIAK, MONICA S (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:S
Last Name:MARCINIAK
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 1:626 FLOWERDALE ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1879
Mailing Address - Country:US
Mailing Address - Phone:586-719-7710
Mailing Address - Fax:
Practice Address - Street 1:50 KIRTS BLVD STE G
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-5310
Practice Address - Country:US
Practice Address - Phone:248-760-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist