Provider Demographics
NPI:1093832883
Name:VANDERPOOL, MARLA LYNN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:LYNN
Last Name:VANDERPOOL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 VULTEE RD
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-8803
Mailing Address - Country:US
Mailing Address - Phone:303-917-6747
Mailing Address - Fax:
Practice Address - Street 1:9892 TITAN PARK CIR STE 8
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80125-9355
Practice Address - Country:US
Practice Address - Phone:303-917-6747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO09126477235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist