MEDICARE: DR. SUSAN MARKS BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1619104361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN MARKS BCBA

Provider Business Mailing Address
First Line	:	906 W UNIVERSITY AVE STE 120
Second Line	:	BCSNA, LLC
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-7115
Country	:	US
Telephone Number	:	928-556-9935
Fax Number	:

Provider Business Practice Location Address
First Line	:	906 W UNIVERSITY AVE STE 120
Second Line	:	BCSNA, LLC
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-7115
Country	:	US
Telephone Number	:	928-556-9935
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2009
Last Update Date	:	05/27/2010

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