Provider Demographics
NPI:1790081305
Name:MARCUS, MARILYN (SLP/CCC)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:MARCUS
Suffix:
Gender:F
Credentials:SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2241
Mailing Address - Country:US
Mailing Address - Phone:541-343-8163
Mailing Address - Fax:
Practice Address - Street 1:735 S 2ND ST
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:OR
Practice Address - Zip Code:97426-7507
Practice Address - Country:US
Practice Address - Phone:971-673-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10252235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR385182Medicare PIN