Provider Demographics
NPI:1174776231
Name:MARK, MARIE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:MARK
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 1:2606 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4136
Mailing Address - Country:US
Mailing Address - Phone:267-994-0121
Mailing Address - Fax:215-638-0922
Practice Address - Street 1:2606 MARION AVE
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4136
Practice Address - Country:US
Practice Address - Phone:267-994-0121
Practice Address - Fax:215-638-0922
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-02
Last Update Date:2008-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL001211L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist