Provider Demographics
NPI:1821032632
Name:BRIGGS, MARLO ANN (MA, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:MARLO
Middle Name:ANN
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:MISS
Other - First Name:MARLO
Other - Middle Name:ANN
Other - Last Name:EDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:810-953-2900
Mailing Address - Fax:
Practice Address - Street 1:3027 E HILL RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8130
Practice Address - Country:US
Practice Address - Phone:810-953-2900
Practice Address - Fax:810-953-3980
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000056231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1821032632Medicaid
MI1821032632Medicaid