Provider Demographics
NPI:1760195622
Name:MARCRUM, MONA KAY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:KAY
Last Name:MARCRUM
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 1:2603 UNDERHILL CT
Mailing Address - Street 2:
Mailing Address - City:THOMPSONS STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37179-9794
Mailing Address - Country:US
Mailing Address - Phone:127-053-5575
Mailing Address - Fax:
Practice Address - Street 1:101 WALNUT LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4943
Practice Address - Country:US
Practice Address - Phone:931-381-3112
Practice Address - Fax:931-381-4870
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000006001235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist