Healthcare Provider Details

I. General information

NPI: 1023194362
Provider Name (Legal Business Name): MARK S. JAMES MS, CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2006
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 S MARYLAND PKWY STE A-5 #469
LAS VEGAS NV
89183-7146
US

IV. Provider business mailing address

9850 S MARYLAND PKWY STE A-5 #469
LAS VEGAS NV
89183-7146
US

V. Phone/Fax

Practice location:
  • Phone: 702-401-4017
  • Fax: 702-616-2526
Mailing address:
  • Phone: 702-401-4017
  • Fax: 702-616-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-774
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: