Provider Demographics
NPI:1487760435
Name:RANKIN, MARILYN ANN (SLP)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:ANN
Last Name:RANKIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100722
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76185-0722
Mailing Address - Country:US
Mailing Address - Phone:817-247-0645
Mailing Address - Fax:817-847-0205
Practice Address - Street 1:3600 HULEN ST
Practice Address - Street 2:SUITE D-1
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6863
Practice Address - Country:US
Practice Address - Phone:817-247-0654
Practice Address - Fax:817-847-0205
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18647235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005908101Medicaid
8T0653OtherBLUE CROSS BLUE SHIELD