Provider Demographics
NPI:1932226677
Name:GRESHAM, MARILYN A (AUD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:A
Last Name:GRESHAM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-4654
Mailing Address - Country:US
Mailing Address - Phone:256-740-8383
Mailing Address - Fax:
Practice Address - Street 1:205 S SEMINARY ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5665
Practice Address - Country:US
Practice Address - Phone:256-740-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN 154237600000X
AL1109A237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter