Provider Demographics
NPI:1083360846
Name:NILAND, MARLEY R (MS, SLP-LTD)
Entity Type:Individual
Prefix:
First Name:MARLEY
Middle Name:R
Last Name:NILAND
Suffix:
Gender:F
Credentials:MS, SLP-LTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1558
Mailing Address - Country:US
Mailing Address - Phone:406-880-7587
Mailing Address - Fax:
Practice Address - Street 1:2126 DIXON AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8216
Practice Address - Country:US
Practice Address - Phone:406-541-2776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-LTD-LIC-142235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist