Doctor Name: | MRS. MARY SHANNON MARCELLA |
NPI Number: | 1205111457 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP-CCC |
License Number: | SP-8408-SL |
Business Practice Address: | 130 Condor St Boston, MA - 021281305 |
Business Phone Number: | 6175696560 |
Business Fax Number: | |
Mailing Address: | 90 Fremont St, WINTHROP |
State: | MA |
Postal Code: | 021522647 |
Phone Number: | 5083319999 |
Fax Number: | |
NPI Enumeration Date: | 10/19/2011 |
NPI Last Update Date: | 10/19/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SP-8408-SL |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |