Provider Demographics
NPI:1801358007
Name:FARRIOR, MARLA MADAN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:MADAN
Last Name:FARRIOR
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 W BARCELONA ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6704
Mailing Address - Country:US
Mailing Address - Phone:908-868-1643
Mailing Address - Fax:
Practice Address - Street 1:724 BOWING OAK DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5974
Practice Address - Country:US
Practice Address - Phone:813-982-3695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14198411235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty