Active NPI
Marissa Parks
- Speech-Language Pathologist
- Wisconsin Rapids, WI
National Provider Identifier
1639651789
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 4718-154
- Practice address
- 111 W Jackson St
Wisconsin Rapids, WI 54495-2702 - Phone
- (715) 421-8840
- NPI assigned
- Sep 5, 2018
- Last updated
- Sep 5, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 4718-154 | WI | Primary |
Addresses
Primary practice location
111 W Jackson St
Wisconsin Rapids, WI 54495-2702
Mailing address
1116 N Point Dr Apt C12
Stevens Point, WI 54481-1190
Phone (609) 501-8227
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4718-154 | WI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536105600000",
"number": "1639651789",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1116 N POINT DR APT C12",
"city": "STEVENS POINT",
"state": "WI",
"postal_code": "544811190",
"telephone_number": "609-501-8227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 W JACKSON ST",
"city": "WISCONSIN RAPIDS",
"state": "WI",
"postal_code": "544952702",
"telephone_number": "715-421-8840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARKS",
"first_name": "MARISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-05",
"last_updated": "2018-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WI",
"license": "4718-154",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wisconsin Rapids, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.