Provider Demographics
NPI:1710027768
Name:SIMMONS, MARIE VEST (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:VEST
Last Name:SIMMONS
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 1:6108 HAMPTON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-9264
Mailing Address - Country:US
Mailing Address - Phone:919-661-7247
Mailing Address - Fax:
Practice Address - Street 1:6108 HAMPTON RIDGE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-9264
Practice Address - Country:US
Practice Address - Phone:919-661-7247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7476179Medicaid