Provider Demographics
NPI:1568512291
Name:MARLER, GINA R (MED CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:R
Last Name:MARLER
Suffix:
Gender:F
Credentials:MED CCC SLP
Other - Prefix:
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Mailing Address - Street 1:400 OHIO AVE S #177
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064
Mailing Address - Country:US
Mailing Address - Phone:386-397-4883
Mailing Address - Fax:888-841-9040
Practice Address - Street 1:609 5TH STREET SW SUITE 3
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064
Practice Address - Country:US
Practice Address - Phone:386-362-8580
Practice Address - Fax:888-841-9040
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4901235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884661800Medicaid
FLS2717OtherBLUECROSS BLUESHIELD