Provider Demographics
NPI:1538607924
Name:HENNIGAN, MARISSA (BS-SLPA)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:HENNIGAN
Suffix:
Gender:F
Credentials:BS-SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 N 70TH ST APT 2002
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6385
Mailing Address - Country:US
Mailing Address - Phone:951-285-8091
Mailing Address - Fax:
Practice Address - Street 1:10631 S 51ST ST
Practice Address - Street 2:SUTIE 8
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5225
Practice Address - Country:US
Practice Address - Phone:480-398-4280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA102812355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant