MEDICARE: MRS. CLARISSA MARQUIS-COLVARD MS, CCC-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	15300	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558365338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CLARISSA MARQUIS-COLVARD MS, CCC-SLP

Provider Business Mailing Address
First Line	:	1900 N OREGON ST
Second Line	:	STE 420
City	:	EL PASO
State	:	TX
Zip	:	79902-3351
Country	:	US
Telephone Number	:	915-533-1388
Fax Number	:	915-533-2933

Provider Business Practice Location Address
First Line	:	1900 N OREGON ST
Second Line	:	STE 420
City	:	EL PASO
State	:	TX
Zip	:	79902-3351
Country	:	US
Telephone Number	:	915-533-1388
Fax Number	:	915-533-2933

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	10/08/2009

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