Provider Demographics
NPI:1972092484
Name:BRUTON, MARLA (MS, CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:
Last Name:BRUTON
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 MAYO DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22935-1370
Mailing Address - Country:US
Mailing Address - Phone:434-939-9002
Mailing Address - Fax:
Practice Address - Street 1:64 MONROE DR
Practice Address - Street 2:
Practice Address - City:STANARDSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22973-2850
Practice Address - Country:US
Practice Address - Phone:434-939-9002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008623235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist