Provider Demographics
NPI:1356499982
Name:ZOLLER, MARIE K (SLP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:K
Last Name:ZOLLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N TILLOTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-3900
Mailing Address - Country:US
Mailing Address - Phone:765-254-9735
Mailing Address - Fax:765-254-9739
Practice Address - Street 1:205 N TILLOTSON AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-3900
Practice Address - Country:US
Practice Address - Phone:765-254-9735
Practice Address - Fax:765-254-9739
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004099A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist