Provider Demographics
NPI:1699029058
Name:PHILPOTT, MARILYN LEE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:LEE
Last Name:PHILPOTT
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 1:10807 66TH PL NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-9090
Mailing Address - Country:US
Mailing Address - Phone:425-418-7036
Mailing Address - Fax:
Practice Address - Street 1:1237 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2028
Practice Address - Country:US
Practice Address - Phone:360-794-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL000003865235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist