Provider Demographics
NPI:1447477039
Name:JARVIS, MARNY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARNY
Middle Name:
Last Name:JARVIS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 W SPENCER PL
Mailing Address - Street 2:
Mailing Address - City:THATCHER
Mailing Address - State:AZ
Mailing Address - Zip Code:85552-5413
Mailing Address - Country:US
Mailing Address - Phone:928-348-0711
Mailing Address - Fax:
Practice Address - Street 1:150 E. 4TH SOUTH
Practice Address - Street 2:
Practice Address - City:PIMA
Practice Address - State:AZ
Practice Address - Zip Code:85543-8554
Practice Address - Country:US
Practice Address - Phone:928-348-7230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4538235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist