Provider Demographics
NPI:1871151589
Name:BISSELLE, MARION SABRINA
Entity type:Individual
Prefix:MRS
First Name:MARION
Middle Name:SABRINA
Last Name:BISSELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TSCHIFFELY SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5630
Mailing Address - Country:US
Mailing Address - Phone:240-740-1840
Mailing Address - Fax:
Practice Address - Street 1:100 TSCHIFFELY SQUARE RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5630
Practice Address - Country:US
Practice Address - Phone:240-740-1840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01675235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist