Provider Demographics
NPI:1922301944
Name:RAMAHLO, MARIANNE WAGAMAN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:WAGAMAN
Last Name:RAMAHLO
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 1:541 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-9608
Mailing Address - Country:US
Mailing Address - Phone:305-812-0596
Mailing Address - Fax:
Practice Address - Street 1:1381 BARCELONA WAY
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33327-1747
Practice Address - Country:US
Practice Address - Phone:305-812-0596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13161235Z00000X
FLSZ6191235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist