Provider Demographics
NPI:1548678741
Name:MARLER, JEFFREY A (PHD CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:MARLER
Suffix:
Gender:M
Credentials:PHD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 N CARROLL AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6452
Mailing Address - Country:US
Mailing Address - Phone:817-416-5374
Mailing Address - Fax:
Practice Address - Street 1:430 N CARROLL AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6452
Practice Address - Country:US
Practice Address - Phone:817-416-5374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107831OtherLISCENCE
TX46-0918413OtherTAX ID