Provider Demographics
NPI:1497885842
Name:ADDISON, MARGIE FAY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARGIE
Middle Name:FAY
Last Name:ADDISON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:629 SW MORRIS STEEN RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32331-3815
Mailing Address - Country:US
Mailing Address - Phone:850-843-1052
Mailing Address - Fax:850-948-3952
Practice Address - Street 1:214 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2744
Practice Address - Country:US
Practice Address - Phone:850-843-1052
Practice Address - Fax:850-948-3952
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8913235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist