=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669787578
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALIE MARKS M.S.,CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2010
-----------------------------------------------------
Last Update Date | 01/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 407 CARSON ST
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71901-6852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-815-4998
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1959 GRAY LOOP
-----------------------------------------------------
City | LEOLA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72084-8919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-815-4998
-----------------------------------------------------
Fax | 501-815-4998
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 182430721
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------