Provider Demographics
NPI:1962660860
Name:OWENS-GICK, MARILYN SUE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:SUE
Last Name:OWENS-GICK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHALMERS
Mailing Address - State:IN
Mailing Address - Zip Code:47929
Mailing Address - Country:US
Mailing Address - Phone:765-490-1106
Mailing Address - Fax:
Practice Address - Street 1:107 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHALMERS
Practice Address - State:IN
Practice Address - Zip Code:47929
Practice Address - Country:US
Practice Address - Phone:765-490-1106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004628A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist