Provider Demographics
NPI:1225151616
Name:DR. MARILYN J. BUZOLICH
Entity Type:Organization
Organization Name:DR. MARILYN J. BUZOLICH
Other - Org Name:ACTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER DIRECTOR AAC SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BUZOLICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC SLP
Authorized Official - Phone:415-333-7739
Mailing Address - Street 1:350 SANTA ANA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1953
Mailing Address - Country:US
Mailing Address - Phone:415-333-7739
Mailing Address - Fax:415-333-3456
Practice Address - Street 1:350 SANTA ANA AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1953
Practice Address - Country:US
Practice Address - Phone:415-333-7739
Practice Address - Fax:415-333-3456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP3300OtherLICENSE SPEECH LANGUAGE