Healthcare Provider Details

I. General information

NPI: 1366242596
Provider Name (Legal Business Name): MONICA MARIE MARKS M.S., ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONICA MARIE WYHOWANEC M.S., ED.S.

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 CARAVELLE DR
LAKE HAVASU CITY AZ
86406-6146
US

IV. Provider business mailing address

2906 CARAVELLE DR
LAKE HAVASU CITY AZ
86406-6146
US

V. Phone/Fax

Practice location:
  • Phone: 928-230-8058
  • Fax:
Mailing address:
  • Phone: 928-230-8058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number5549656
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: