Provider Demographics
NPI:1083017461
Name:MARYAN, CAROLYN COYNE
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:COYNE
Last Name:MARYAN
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 1:7709 BELLSTONE RD.
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119
Mailing Address - Country:US
Mailing Address - Phone:314-322-7921
Mailing Address - Fax:
Practice Address - Street 1:400 MINE ST.
Practice Address - Street 2:CITADEL SCHOOL
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664
Practice Address - Country:US
Practice Address - Phone:573-438-2472
Practice Address - Fax:573-436-0361
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant