Provider Demographics
NPI:1144488677
Name:PENDLEY, MARISSA D'AGOSTINO (MS/CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:D'AGOSTINO
Last Name:PENDLEY
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6561 CHESTNUT CIR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-7811
Mailing Address - Country:US
Mailing Address - Phone:239-248-0458
Mailing Address - Fax:239-316-4525
Practice Address - Street 1:800 MEADOWLAND DR
Practice Address - Street 2:UNIT E
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2531
Practice Address - Country:US
Practice Address - Phone:239-431-7305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-31
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004536235Z00000X
FLSA 4153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist