Provider Demographics
NPI:1891026183
Name:MARVIN, LYNDA ANN (PHD, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:ANN
Last Name:MARVIN
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 DUNN HALL
Mailing Address - Street 2:UNIVERSITY OF MAINE CONLEY SPEECH, LANGUAGE AND HEARING
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04469-5724
Mailing Address - Country:US
Mailing Address - Phone:207-581-2006
Mailing Address - Fax:207-581-2060
Practice Address - Street 1:5724 DUNN HALL,
Practice Address - Street 2:ROOM 336 UNIVERSITY OF MAINE
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04469-5724
Practice Address - Country:US
Practice Address - Phone:207-581-2006
Practice Address - Fax:207-581-2060
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1979235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME435063199Medicaid