Healthcare Provider Details

I. General information

NPI: 1528457751
Provider Name (Legal Business Name): MARJORIE RUTH HERRON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARJORIE RUTH HERRON BCABA, LABA

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1354 8TH ST SW
ROANOKE VA
24015-1812
US

IV. Provider business mailing address

3470 BRADSHAW RD
SALEM VA
24153-8712
US

V. Phone/Fax

Practice location:
  • Phone: 434-942-6392
  • Fax: 540-384-6308
Mailing address:
  • Phone: 434-942-6392
  • Fax: 540-384-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0134000019
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: