MEDICARE: MRS. CYNTHIA MORGAN MARSTIN MS CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2202002807	VA

General Provider Information

NPI Number	:	1790183903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA MORGAN MARSTIN MS CCC-SLP

Provider Business Mailing Address
First Line	:	6405 BOYDTON PLANK ROAD
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-7401
Country	:	US
Telephone Number	:	804-518-0780
Fax Number	:

Provider Business Practice Location Address
First Line	:	6405 BOYDTON PLANK ROAD
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-7401
Country	:	US
Telephone Number	:	804-518-0780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2014
Last Update Date	:	12/22/2014

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