Provider Demographics
NPI:1003684515
Name:ANDERSON, MARIAN SHARLENE
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:SHARLENE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 VISTA VIEW CT
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-2656
Mailing Address - Country:US
Mailing Address - Phone:801-872-7844
Mailing Address - Fax:
Practice Address - Street 1:641 VISTA VIEW CT
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-2656
Practice Address - Country:US
Practice Address - Phone:703-473-1404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13735145-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist