Provider Demographics
NPI:1912464439
Name:GRUBER, MARNI ERIN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARNI
Middle Name:ERIN
Last Name:GRUBER
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 1:901 ROUTE 73 N STE B
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1226
Mailing Address - Country:US
Mailing Address - Phone:856-983-3390
Mailing Address - Fax:
Practice Address - Street 1:901 ROUTE 73 N STE B
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1226
Practice Address - Country:US
Practice Address - Phone:856-983-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00929100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41YS00929100OtherSTATE LICENSE