Provider Demographics
NPI:1740771906
Name:SCHUBERT, MARIANNE (MACCCSLP)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:SCHUBERT
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 DUNBAR RD
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-3103
Mailing Address - Country:US
Mailing Address - Phone:330-633-4515
Mailing Address - Fax:
Practice Address - Street 1:731 DUNBAR RD
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-3103
Practice Address - Country:US
Practice Address - Phone:330-633-4515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP3654235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist