Active NPI
Marilyn T Davis, SLP
- Speech-Language Pathologist
- Albuquerque, NM
National Provider Identifier
1376680249
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 849
- Practice address
- 601 4TH St SW
Coronado Complex
Albuquerque, NM 87102-3840 - Phone
- (505) 247-1012
- NPI assigned
- Jan 31, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 849 | NM | Primary |
Addresses
Primary practice location
601 4TH St SW
Coronado Complex
Albuquerque, NM 87102-3840
Mailing address
601 4TH St SW
Coronado Complex
Albuquerque, NM 87102-3840
Phone (505) 247-1012
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 75765 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 849 | NM | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1376680249",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 4TH ST SW",
"address_2": "CORONADO COMPLEX",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871023840",
"telephone_number": "505-247-1012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 4TH ST SW",
"address_2": "CORONADO COMPLEX",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871023840",
"telephone_number": "505-247-1012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "MARILYN",
"middle_name": "T",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-31",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NM",
"license": "849",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "75765",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.