Provider Demographics
NPI:1497996227
Name:WILLINGHAM, MARIVEL S (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARIVEL
Middle Name:S
Last Name:WILLINGHAM
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S. JACKSON
Mailing Address - Street 2:STE. 2 & 3
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503
Mailing Address - Country:US
Mailing Address - Phone:956-630-4400
Mailing Address - Fax:956-630-4447
Practice Address - Street 1:1900 S. JACKSON
Practice Address - Street 2:STE. 2 & 3
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503
Practice Address - Country:US
Practice Address - Phone:956-630-4400
Practice Address - Fax:956-630-4447
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX#101473235Z00000X
TX101473235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist