Provider Demographics
NPI:1962491530
Name:MASCHGAN, MARILYN GAIL (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:GAIL
Last Name:MASCHGAN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N PECOS RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1349
Mailing Address - Country:US
Mailing Address - Phone:702-732-3800
Mailing Address - Fax:702-732-4747
Practice Address - Street 1:301 N PECOS RD
Practice Address - Street 2:SUITE G
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1349
Practice Address - Country:US
Practice Address - Phone:702-732-3800
Practice Address - Fax:702-732-4747
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-17231H00000X
NV#8237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1962491530Medicaid
NVS25089Medicare UPIN
NV1962491530Medicaid