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General NPI Number Information
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NPI Number | 1083017461
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Entity Type | Individual
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Provider Name | MS. CAROLYN COYNE MARYAN
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Gender | Female
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Dates
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Enumeration Date | 09/30/2014
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Last Update Date | 09/30/2014
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Provider Practice Location Address
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Address Line | 400 MINE ST. CITADEL SCHOOL
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City | POTOSI
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State | MO
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Zip | 63664
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Country | US
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Telephone | 573-438-2472
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Fax | 573-436-0361
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Provider Business Mailing Address
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Address Line | 7709 BELLSTONE RD.
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City | ST. LOUIS
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State | MO
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Zip | 63119
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Country | US
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Telephone | 314-322-7921
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State |
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