Provider Demographics
NPI:1922492768
Name:CONLON, MARJORIE (SLP)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:CONLON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 S 8TH ST APT 32
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-6162
Mailing Address - Country:US
Mailing Address - Phone:347-628-4055
Mailing Address - Fax:
Practice Address - Street 1:190 S 8TH ST APT 32
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-6162
Practice Address - Country:US
Practice Address - Phone:347-628-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1251950235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist