Provider Demographics
NPI:1689701831
Name:HART, MARILYN S (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:S
Last Name:HART
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 JULIA DR
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-9047
Mailing Address - Country:US
Mailing Address - Phone:256-442-4006
Mailing Address - Fax:
Practice Address - Street 1:401 BAY ST # A
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5107
Practice Address - Country:US
Practice Address - Phone:256-546-2799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890012700Medicaid
AL51525952OtherBCBS