Provider Demographics
NPI:1043659410
Name:SALEM, MARIANNE CARLISLE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:CARLISLE
Last Name:SALEM
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12830 SE CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-6804
Mailing Address - Country:US
Mailing Address - Phone:772-485-0669
Mailing Address - Fax:
Practice Address - Street 1:12830 SE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-6804
Practice Address - Country:US
Practice Address - Phone:772-485-0669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6458235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist