Provider Demographics
NPI:1932275369
Name:MARONEY, MARSHA R (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:R
Last Name:MARONEY
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 1:900 CHEYENNE RD
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-7639
Mailing Address - Country:US
Mailing Address - Phone:417-225-1636
Mailing Address - Fax:
Practice Address - Street 1:900 CHEYENNE RD
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-7639
Practice Address - Country:US
Practice Address - Phone:417-225-1636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007023406235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOM205186004OtherMO DRIVER LICENSE