Provider Demographics
NPI:1205271848
Name:WEATHERSPOON, MARILYN A (MSW)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:A
Last Name:WEATHERSPOON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:WEATHERSPOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 3166
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32315-3166
Mailing Address - Country:US
Mailing Address - Phone:850-509-2586
Mailing Address - Fax:850-385-0910
Practice Address - Street 1:2329 EMERALD RIDGE LOOP
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-9300
Practice Address - Country:US
Practice Address - Phone:850-509-2586
Practice Address - Fax:850-385-0910
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL674683798Medicaid
FL674683768Medicaid
FL674683796Medicaid