Provider Demographics
NPI:1982472924
Name:MARIONBERRY SPEECH THERAPY, LLC
Entity type:Organization
Organization Name:MARIONBERRY SPEECH THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:BARTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-208-3113
Mailing Address - Street 1:889 MORNING GLORY DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97351-9580
Mailing Address - Country:US
Mailing Address - Phone:971-208-3113
Mailing Address - Fax:971-456-0092
Practice Address - Street 1:889 MORNING GLORY DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351-9580
Practice Address - Country:US
Practice Address - Phone:971-208-3113
Practice Address - Fax:971-456-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty