Provider Demographics
NPI:1255540886
Name:ERL, MARJORIE ANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:ANNE
Last Name:ERL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 AUGUSTA CT
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-7721
Mailing Address - Country:US
Mailing Address - Phone:859-657-6881
Mailing Address - Fax:859-657-6881
Practice Address - Street 1:10134 OLD UNION RD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-8508
Practice Address - Country:US
Practice Address - Phone:859-301-7232
Practice Address - Fax:859-301-7240
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0136235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01013671Medicaid