Provider Demographics
NPI:1629479183
Name:PITTMAN, MARION ELIZABETH (MED CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARION
Middle Name:ELIZABETH
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 OHIO AVE S UNIT 177
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-7707
Mailing Address - Country:US
Mailing Address - Phone:386-362-3231
Mailing Address - Fax:
Practice Address - Street 1:609 5TH ST SW
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-2216
Practice Address - Country:US
Practice Address - Phone:386-362-3231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13817235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist