Healthcare Provider Details

I. General information

NPI: 1194680611
Provider Name (Legal Business Name): MARISA HERSKOVITZ MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 ROUTE 73 N
MARLTON NJ
08053-1274
US

IV. Provider business mailing address

851 ROUTE 73 N
MARLTON NJ
08053-1274
US

V. Phone/Fax

Practice location:
  • Phone: 856-983-3390
  • Fax:
Mailing address:
  • Phone: 856-983-3390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS00441600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: