MEDICARE: MRS. MARIE ROBERTS HENDRIX M.ED., 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	1494	GA

General Provider Information

NPI Number	:	1851468292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIE ROBERTS HENDRIX M.ED., CCC-SLP

Provider Business Mailing Address
First Line	:	891 N FAIRVIEW RD
Second Line	:
City	:	LAVONIA
State	:	GA
Zip	:	30553-3317
Country	:	US
Telephone Number	:	706-356-8296
Fax Number	:	706-384-3727

Provider Business Practice Location Address
First Line	:	521 FRANKLIN SPRINGS STREET
Second Line	:
City	:	ROYSTON
State	:	GA
Zip	:	30662-3934
Country	:	US
Telephone Number	:	706-245-1822
Fax Number	:	706-245-1854

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/09/2007

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Directions to “ MRS. MARIE ROBERTS HENDRIX M.ED., CCC-SLP” Practice Location

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