Provider Demographics
NPI:1225767619
Name:MYRICK, MARIA (MS, SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:MYRICK
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:ROELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5406 JEAN ELLEN ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2908
Mailing Address - Country:US
Mailing Address - Phone:906-282-7913
Mailing Address - Fax:
Practice Address - Street 1:520 N 28TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4101
Practice Address - Country:US
Practice Address - Phone:715-845-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist