Healthcare Provider Details

I. General information

NPI: 1033348016
Provider Name (Legal Business Name): TAMMY L MARKS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 NONC LOL DR
ARNAUDVILLE LA
70512-5739
US

IV. Provider business mailing address

518 NONC LOL DR
ARNAUDVILLE LA
70512-5739
US

V. Phone/Fax

Practice location:
  • Phone: 337-754-8214
  • Fax: 337-261-6416
Mailing address:
  • Phone: 337-754-8214
  • Fax: 337-261-6416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4341
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: