MEDICARE: MARILYNN LOVE SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLPLPA00218479	KY

General Provider Information

NPI Number	:	1649657867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYNN LOVE SLP

Provider Business Mailing Address
First Line	:	250 OXFORD PL
Second Line	:
City	:	COLUMBIA
State	:	KY
Zip	:	42728-8462
Country	:	US
Telephone Number	:	270-993-8745
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 OXFORD PL
Second Line	:
City	:	COLUMBIA
State	:	KY
Zip	:	42728-8462
Country	:	US
Telephone Number	:	270-993-8745
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2015
Last Update Date	:	04/27/2015

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Directions to “ MARILYNN LOVE SLP” Practice Location

Language	Start Address	Practice Location

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