Provider Demographics
NPI:1790948057
Name:AVEN, MARVA JOAN (AUD)
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:JOAN
Last Name:AVEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7675 WOLF RIVER CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1748
Mailing Address - Country:US
Mailing Address - Phone:901-682-1529
Mailing Address - Fax:901-761-0592
Practice Address - Street 1:7675 WOLF RIVER CIR STE 101
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1748
Practice Address - Country:US
Practice Address - Phone:901-682-1529
Practice Address - Fax:901-761-0592
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA118231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02134581Medicaid
TNQ034298Medicaid