Provider Demographics
NPI:1376896480
Name:MOUDY, MARIANNA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNA
Middle Name:
Last Name:MOUDY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39237 258TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-8867
Mailing Address - Country:US
Mailing Address - Phone:817-721-7350
Mailing Address - Fax:
Practice Address - Street 1:22443 SE 240TH PL
Practice Address - Street 2:SUITE B101
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5898
Practice Address - Country:US
Practice Address - Phone:425-358-4885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60306687235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist