Provider Demographics
NPI:1689731176
Name:MONGER, MARILYNN M (MS CCC)
Entity Type:Individual
Prefix:MRS
First Name:MARILYNN
Middle Name:M
Last Name:MONGER
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 OAK DRIVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7517
Mailing Address - Country:US
Mailing Address - Phone:970-247-4052
Mailing Address - Fax:
Practice Address - Street 1:1291 OAK DRIVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7517
Practice Address - Country:US
Practice Address - Phone:970-247-4052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0267382235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01185349Medicaid