Provider Demographics
NPI:1306583489
Name:TARRANT, MARLEE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARLEE
Middle Name:
Last Name:TARRANT
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 1:6230 N BELT LINE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2657
Mailing Address - Country:US
Mailing Address - Phone:469-320-1700
Mailing Address - Fax:469-320-1732
Practice Address - Street 1:6230 N BELT LINE RD STE 300
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2657
Practice Address - Country:US
Practice Address - Phone:469-320-1700
Practice Address - Fax:469-320-1732
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119620OtherTDLR
TXQMP000006468443Medicaid