Provider Demographics
NPI:1295908143
Name:CALDEMEYER, MARILYN R
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:R
Last Name:CALDEMEYER
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 1:7561 S COUNTY ROAD 900 E
Mailing Address - Street 2:
Mailing Address - City:VELPEN
Mailing Address - State:IN
Mailing Address - Zip Code:47590-8960
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7561 S COUNTY ROAD 900 E
Practice Address - Street 2:
Practice Address - City:VELPEN
Practice Address - State:IN
Practice Address - Zip Code:47590-8960
Practice Address - Country:US
Practice Address - Phone:812-549-6659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004466A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22004466AOtherLICENSE