Provider Demographics
NPI:1659525749
Name:NEGRON, MARILYN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:NEGRON
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 1:202 PALMWOOD CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-8609
Mailing Address - Country:US
Mailing Address - Phone:407-910-6230
Mailing Address - Fax:
Practice Address - Street 1:147 PARSONS RD
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-2748
Practice Address - Country:US
Practice Address - Phone:407-252-4651
Practice Address - Fax:407-641-8633
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014642235Z00000X
FL11819235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12333429OtherCAQH