Provider Demographics
NPI:1073894853
Name:MARRON, JANET JOHNSON (MED CCCSLP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:JOHNSON
Last Name:MARRON
Suffix:
Gender:F
Credentials:MED CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 AUGUSTA VALLEY LN SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-8924
Mailing Address - Country:US
Mailing Address - Phone:919-602-4511
Mailing Address - Fax:
Practice Address - Street 1:1955 AUGUSTA VALLEY LN SE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-8924
Practice Address - Country:US
Practice Address - Phone:919-602-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1205082235Z00000X
MI7101006400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist