Provider Demographics
NPI:1710437793
Name:MARGOLIN, MARINA (MS, SLP-CCC)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:MARGOLIN
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 RIVER DR APT 1
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-9672
Mailing Address - Country:US
Mailing Address - Phone:615-429-4589
Mailing Address - Fax:
Practice Address - Street 1:20 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-9715
Practice Address - Country:US
Practice Address - Phone:413-584-5057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist