Provider Demographics
NPI:1760627186
Name:MUDRI, MARJORIE V (MS SLP/CCC)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:V
Last Name:MUDRI
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 1:257 SEAGATE CT
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-4228
Mailing Address - Country:US
Mailing Address - Phone:727-733-8172
Mailing Address - Fax:727-733-8176
Practice Address - Street 1:257 SEAGATE CT
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-4228
Practice Address - Country:US
Practice Address - Phone:727-733-8172
Practice Address - Fax:727-733-8176
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 967235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist