Healthcare Provider Details

I. General information

NPI: 1972624195
Provider Name (Legal Business Name): MARION ELIZABETH MAY I SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 VARIEL AVE SUITE A
WOODLAND HILLS CA
91367-2514
US

IV. Provider business mailing address

4760 VIA DON LUIS
NEWBURY PARK CA
91320-6878
US

V. Phone/Fax

Practice location:
  • Phone: 818-888-4559
  • Fax:
Mailing address:
  • Phone: 805-480-9982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: