Provider Demographics
NPI:1013298686
Name:MARX, RANDY LEROY
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:LEROY
Last Name:MARX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 NWAKAMA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-5530
Mailing Address - Country:US
Mailing Address - Phone:507-337-4500
Mailing Address - Fax:507-337-4502
Practice Address - Street 1:1401 NWAKAMA ST STE 100
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-5530
Practice Address - Country:US
Practice Address - Phone:507-337-4500
Practice Address - Fax:507-337-4502
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2612237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist