Provider Demographics
NPI:1366086811
Name:CROSSLEY, MARILYN RIVKIN
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:RIVKIN
Last Name:CROSSLEY
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 1:2221 GRUBE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2642
Mailing Address - Country:US
Mailing Address - Phone:937-399-8941
Mailing Address - Fax:937-399-5639
Practice Address - Street 1:2221 GRUBE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2642
Practice Address - Country:US
Practice Address - Phone:937-399-8941
Practice Address - Fax:937-399-5639
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP01836235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist