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General NPI Number Information
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NPI Number | 1811109242
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Entity Type | Individual
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Provider Name | MARIANA MARITATO M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/06/2007
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Last Update Date | 07/01/2013
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Provider Practice Location Address
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Address Line | 718 MAIN ST # 1A
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City | CALDWELL
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State | ID
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Zip | 83605-3744
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Country | US
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Telephone | 208-649-5036
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Fax |
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Provider Business Mailing Address
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Address Line | 213 ABRAHAM WAY APT 101
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City | CALDWELL
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State | ID
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Zip | 83607-5280
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Country | US
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Telephone | 208-649-5036
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP4459
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP-2225
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License Number State | ID
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