Provider Demographics
NPI:1063875805
Name:GOERTEL-BREEN, MARILYN (SLP)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
Last Name:GOERTEL-BREEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14440 N 51ST AVE W
Mailing Address - Street 2:
Mailing Address - City:MINGO
Mailing Address - State:IA
Mailing Address - Zip Code:50168-8544
Mailing Address - Country:US
Mailing Address - Phone:515-577-8847
Mailing Address - Fax:
Practice Address - Street 1:12251 HIGHWAY 41 N
Practice Address - Street 2:SUITE A
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-7014
Practice Address - Country:US
Practice Address - Phone:812-868-1224
Practice Address - Fax:866-715-9733
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist