Provider Demographics
NPI:1104396936
Name:MARIN, DARBY JOHANNA (SLPA)
Entity Type:Individual
Prefix:MRS
First Name:DARBY
Middle Name:JOHANNA
Last Name:MARIN
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:MISS
Other - First Name:DARBY
Other - Middle Name:JOHANNA
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLPA
Mailing Address - Street 1:15643 SHERMAN WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4177
Mailing Address - Country:US
Mailing Address - Phone:818-788-4121
Mailing Address - Fax:
Practice Address - Street 1:15643 SHERMAN WAY STE 300
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4177
Practice Address - Country:US
Practice Address - Phone:818-788-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA20082355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant