Provider Demographics
NPI:1245480789
Name:DICELLO, MARLO KAY (MS, CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:MARLO
Middle Name:KAY
Last Name:DICELLO
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 1:6 NO NAME RD
Mailing Address - Street 2:
Mailing Address - City:OLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19547-8648
Mailing Address - Country:US
Mailing Address - Phone:610-987-0988
Mailing Address - Fax:610-987-0988
Practice Address - Street 1:2851 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-2567
Practice Address - Country:US
Practice Address - Phone:610-750-6514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-21
Last Update Date:2008-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005289L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist