Provider Demographics
NPI:1871824284
Name:FREEMAN, MARILYN ANN (MA-CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:ANN
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MA-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ALBERTO WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5404
Mailing Address - Country:US
Mailing Address - Phone:877-991-0009
Mailing Address - Fax:877-991-0009
Practice Address - Street 1:401 ALBERTO WAY
Practice Address - Street 2:SUITE C
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-5404
Practice Address - Country:US
Practice Address - Phone:877-991-0009
Practice Address - Fax:877-991-0009
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP11884235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist