Provider Demographics
NPI:1154607745
Name:SHAW, MARILYN ROSE (MA, CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:ROSE
Last Name:SHAW
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Gender:F
Credentials:MA, CCC/SLP
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Mailing Address - Street 1:2705 STATE HIGHWAY 28
Mailing Address - Street 2:THE SCHOOL AT SPRINGBROOK
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-3153
Mailing Address - Country:US
Mailing Address - Phone:607-286-7171
Mailing Address - Fax:607-286-7166
Practice Address - Street 1:2705 STATE HIGHWAY 28
Practice Address - Street 2:THE SCHOOL AT SPRINGBROOK
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-3153
Practice Address - Country:US
Practice Address - Phone:607-286-7171
Practice Address - Fax:607-286-7166
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY008108-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist