Healthcare Provider Details

I. General information

NPI: 1205090123
Provider Name (Legal Business Name): MARCELLINE LEA FUERCH M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HOLE IN ONE DR
HAYESVILLE NC
28904-1087
US

IV. Provider business mailing address

240 HOLE IN ONE DR
HAYESVILLE NC
28904-1087
US

V. Phone/Fax

Practice location:
  • Phone: 646-309-5338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15191
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: