Provider Demographics
NPI:1689198970
Name:MARZLUF, LAURA D (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:D
Last Name:MARZLUF
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-3942
Mailing Address - Country:US
Mailing Address - Phone:618-558-9163
Mailing Address - Fax:
Practice Address - Street 1:2124 COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-3942
Practice Address - Country:US
Practice Address - Phone:618-558-9163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007920235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist