Provider Demographics
NPI:1205187572
Name:SIMPSON-WALKER, MARIANA (SLP)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:SIMPSON-WALKER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MARIANA
Other - Middle Name:
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4262 CLAUSELL CT STE A
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-1916
Mailing Address - Country:US
Mailing Address - Phone:678-713-4609
Mailing Address - Fax:844-308-4956
Practice Address - Street 1:4262 CLAUSELL CT STE A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035
Practice Address - Country:US
Practice Address - Phone:678-713-4609
Practice Address - Fax:844-308-4956
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SLP007933235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist