Provider Demographics
NPI:1114266087
Name:WARNER, MARGUERITE LEIGH (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:LEIGH
Last Name:WARNER
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 KELLY AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4709
Mailing Address - Country:US
Mailing Address - Phone:434-979-8628
Mailing Address - Fax:434-979-8536
Practice Address - Street 1:1281 SWAN LAKE DR
Practice Address - Street 2:#208
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-8215
Practice Address - Country:US
Practice Address - Phone:434-979-8628
Practice Address - Fax:434-979-8536
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006919235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4980671Medicaid
VA496678Medicare UPIN