| NPI | 1154404374 |
|---|---|
| Former Name | MARISSA J DOUGLAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WI 2859-154) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MN 8287) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2020-02-25 |