MEDICARE: MARISSA VETICA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SL011206	PA

General Provider Information

NPI Number	:	1104185917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA VETICA

Provider Business Mailing Address
First Line	:	8000 CRANBERRY SPRINGS DR
Second Line	:	SUITE 100
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-6687
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8000 CRANBERRY SPRINGS DR
Second Line	:	SUITE 100
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-6687
Country	:	US
Telephone Number	:	724-720-3050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2012
Last Update Date	:	06/15/2021

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Directions to “ MARISSA VETICA ” Practice Location

Language	Start Address	Practice Location

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