Provider Demographics
NPI:1740381573
Name:MARANVILLE, JUNE K (MSP, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JUNE
Middle Name:K
Last Name:MARANVILLE
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 BRIDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2277
Mailing Address - Country:US
Mailing Address - Phone:803-356-5665
Mailing Address - Fax:
Practice Address - Street 1:107 WATERWAY CT # C
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-6812
Practice Address - Country:US
Practice Address - Phone:803-315-0598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1522235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSAO175Medicaid