Provider Demographics
NPI:1770016156
Name:SAMBLANET, MARCUS WILLIAM (MA, CF-SLP)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:WILLIAM
Last Name:SAMBLANET
Suffix:
Gender:M
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-3938
Mailing Address - Country:US
Mailing Address - Phone:330-933-8115
Mailing Address - Fax:
Practice Address - Street 1:1819 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-3938
Practice Address - Country:US
Practice Address - Phone:330-933-8115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND. 2016283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1Medicaid