Provider Demographics
NPI:1285759167
Name:STEVENSON, MARLAINA RAYE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARLAINA
Middle Name:RAYE
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 MAPLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:15338-1001
Mailing Address - Country:US
Mailing Address - Phone:724-943-3677
Mailing Address - Fax:
Practice Address - Street 1:161 BAKERS RIDGE RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1459
Practice Address - Country:US
Practice Address - Phone:304-285-0692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05368235Z00000X
WVSLP-1062235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
49303OtherVITAL STIM
12078256OtherNOMS