Provider Demographics
NPI:1417292293
Name:PYLES HUBERT, MARJORIE ELIZABETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ELIZABETH
Last Name:PYLES HUBERT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JIJI
Other - Middle Name:
Other - Last Name:HUBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2550 SYCAMORE LN
Mailing Address - Street 2:3D
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-5901
Mailing Address - Country:US
Mailing Address - Phone:530-297-5454
Mailing Address - Fax:
Practice Address - Street 1:2550 SYCAMORE LN
Practice Address - Street 2:3D
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-5901
Practice Address - Country:US
Practice Address - Phone:530-297-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15950235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist