Provider Demographics
NPI:1851468292
Name:HENDRIX, MARIE ROBERTS (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ROBERTS
Last Name:HENDRIX
Suffix:
Gender:M
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 N FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LAVONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30553-3317
Mailing Address - Country:US
Mailing Address - Phone:706-356-8296
Mailing Address - Fax:706-384-3727
Practice Address - Street 1:521 FRANKLIN SPRINGS STREET
Practice Address - Street 2:
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662-3934
Practice Address - Country:US
Practice Address - Phone:706-245-1822
Practice Address - Fax:706-245-1854
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist