Provider Demographics
NPI:1174220461
Name:ROTHLISBERGER, MARIAN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:ROTHLISBERGER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 CAPE COD BLVD
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1715
Mailing Address - Country:US
Mailing Address - Phone:940-668-0000
Mailing Address - Fax:
Practice Address - Street 1:9350 CAPE COD BLVD
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-1715
Practice Address - Country:US
Practice Address - Phone:940-668-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109043235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist