Provider Demographics
NPI:1447665203
Name:MARENECK, ELLEN C (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:C
Last Name:MARENECK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W 95TH ST
Mailing Address - Street 2:#1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8510
Mailing Address - Country:US
Mailing Address - Phone:212-865-5813
Mailing Address - Fax:
Practice Address - Street 1:40 W 95TH ST
Practice Address - Street 2:#1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-8510
Practice Address - Country:US
Practice Address - Phone:212-865-5813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023639235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist