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NPI Code Detail

MEDICARE: MRS. MARLENE ANN PETTIFORD M.A., CCC-SLP

MEDICARE: MRS. MARLENE ANN PETTIFORD M.A., CCC-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
1235Z00000XSpeech-Language Pathologist22003457AIN

General Provider Information

NPI Number : 1679522155
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARLENE ANN PETTIFORD M.A., CCC-SLP
Provider Business Mailing Address
First Line : 2242 TIMBERCREST DR
Second Line :
City : COLUMBUS
State : IN
Zip : 47203-4001
Country : US
Telephone Number : 812-378-6098
Fax Number : 812-378-6098
Provider Business Practice Location Address
First Line : 2242 TIMBERCREST DR
Second Line :
City : COLUMBUS
State : IN
Zip : 47203-4001
Country : US
Telephone Number : 812-378-6098
Fax Number : 812-378-6098
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. MARLENE ANN PETTIFORD M.A., CCC-SLP” Practice Location

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