Provider Demographics
NPI:1194103663
Name:SPENCER, MARILYN (MCD CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MCD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 S SAVANNAH DR
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-1819
Mailing Address - Country:US
Mailing Address - Phone:405-612-8475
Mailing Address - Fax:
Practice Address - Street 1:2500 S SANGRE RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-2151
Practice Address - Country:US
Practice Address - Phone:405-707-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK380235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist