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General NPI Number Information
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NPI Number | 1184308462
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Entity Type | Individual
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Provider Name | MARISSA SHULMAN M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 5565 S YOSEMITE ST
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-3319
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Country | US
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Telephone | 844-502-7996
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 880086
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City | BOCA RATON
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State | FL
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Zip | 33488-0086
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Country | US
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Telephone | 561-755-3613
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 5365
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License Number State | CO
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