Provider Demographics
NPI:1447703020
Name:SAMUEL, MARIANNE (SLP)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 GREENTHREAD LN
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077
Mailing Address - Country:US
Mailing Address - Phone:317-833-9974
Mailing Address - Fax:866-512-2250
Practice Address - Street 1:9240 GREENTHREAD LN
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077
Practice Address - Country:US
Practice Address - Phone:317-833-9974
Practice Address - Fax:866-512-2250
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004442A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist