Individual provider Active NPI

Stephanie Jill Marz, MA CCC-SLP

  • Speech-Language Pathologist
  • Bend, OR
National Provider Identifier
1669501011
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
11604 Issued in OR
Practice address
1086 NW Stannium Rd
Bend, OR 97701-2165
Phone
(541) 382-2585
Fax
(541) 382-2585
NPI assigned
Mar 3, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 11604 OR Primary

Addresses

Primary practice location

1086 NW Stannium Rd
Bend, OR 97701-2165

Mailing address

1086 NW Stannium Rd.
Bend, OR 97701
Phone (541) 382-2585

Other identifiers 1

IdentifierTypeStateIssuer
297166MedicaidOR

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)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
11604ORMDSpeech-Language Pathologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669501011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1086 NW STANNIUM RD.",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97701",
            "telephone_number": "541-382-2585",
            "fax_number": "541-382-2585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1086 NW STANNIUM RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977012165",
            "telephone_number": "541-382-2585",
            "fax_number": "541-382-2585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARZ",
        "first_name": "STEPHANIE",
        "middle_name": "JILL",
        "credential": "MA CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OR",
            "license": "11604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "297166",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.

Verify at the official NPI Registry.