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General NPI Number Information
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NPI Number | 1629890124
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Entity Type | Individual
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Provider Name | MARKAYLA NICOLE TUCKER M.S., CF-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 401 W WASHINGTON ST
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City | ROCKWALL
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State | TX
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Zip | 75087-3615
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Country | US
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Telephone | 972-722-3892
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Fax |
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Provider Business Mailing Address
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Address Line | 1790 MERCER PKWY APT 1105
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City | FARMERS BRANCH
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State | TX
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Zip | 75234-1432
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Country | US
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Telephone | 318-525-8411
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 123103
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License Number State | TX
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