Provider Demographics
NPI:1215086418
Name:MEYER, MARINA BILBAO (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:BILBAO
Last Name:MEYER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:BILBAO
Other - Last Name:CANUP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1175 OGLETHORPE AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606
Mailing Address - Country:US
Mailing Address - Phone:706-372-4349
Mailing Address - Fax:706-369-6739
Practice Address - Street 1:1175 OGLETHORPE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2129
Practice Address - Country:US
Practice Address - Phone:706-372-4349
Practice Address - Fax:706-369-6739
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP5109235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000931873CMedicaid