MEDICARE: MARCIA LYNN WALSH-AZIZ SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	0002286	CO
2	235Z00000X	Speech-Language Pathologist	146010340	IL

General Provider Information

NPI Number	:	1093018624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA LYNN WALSH-AZIZ SLP

Provider Business Mailing Address
First Line	:	2235 SYRACUSE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-3635
Country	:	US
Telephone Number	:	815-954-4407
Fax Number	:

Provider Business Practice Location Address
First Line	:	2235 SYRACUSE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-3635
Country	:	US
Telephone Number	:	815-954-4407
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2010
Last Update Date	:	01/27/2020

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