| Doctor Name: | MS. CAROLYN COYNE MARYAN |
| NPI Number: | 1083017461 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 400 Mine St. Citadel School Potosi, MO - 63664 |
| Business Phone Number: | 5734382472 |
| Business Fax Number: | 5734360361 |
| Mailing Address: | 7709 Bellstone Rd., ST. LOUIS |
| State: | MO |
| Postal Code: | 63119 |
| Phone Number: | 3143227921 |
| Fax Number: | |
| NPI Enumeration Date: | 09/30/2014 |
| NPI Last Update Date: | 09/30/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2355S0801X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Specialist/Technologist |
| Taxonomy Specialization: | Speech-Language Assistant |
| Taxonomy Definition: | |