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General NPI Number Information
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NPI Number | 1194103663
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Entity Type | Individual
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Provider Name | MARILYN SPENCER M.C.D. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/15/2015
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Last Update Date | 05/15/2015
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Provider Practice Location Address
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Address Line | 2500 S SANGRE RD
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City | STILLWATER
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State | OK
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Zip | 74074-2151
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Country | US
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Telephone | 405-707-5554
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Fax |
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Provider Business Mailing Address
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Address Line | 1402 S SAVANNAH DR
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City | STILLWATER
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State | OK
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Zip | 74074-1819
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Country | US
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Telephone | 405-612-8475
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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 | 380
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License Number State | OK
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