Provider Demographics
NPI:1023260866
Name:CHURCH, MARIE A (MASTER'S DEGREE)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:A
Last Name:CHURCH
Suffix:
Gender:F
Credentials:MASTER'S DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CLEBURNE BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-4435
Mailing Address - Country:US
Mailing Address - Phone:540-674-4889
Mailing Address - Fax:
Practice Address - Street 1:3607 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7014
Practice Address - Country:US
Practice Address - Phone:540-381-6967
Practice Address - Fax:540-381-6968
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101000520237600000X
VA2201000327231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter