Provider Demographics
NPI:1730342130
Name:DAVIS, MARIE TALARICO (MA CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:TALARICO
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:MISS
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:TALARICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC/SLP
Mailing Address - Street 1:610 E ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-2144
Mailing Address - Country:US
Mailing Address - Phone:800-677-1202
Mailing Address - Fax:
Practice Address - Street 1:5500 BROOKTREE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9260
Practice Address - Country:US
Practice Address - Phone:800-677-1202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL002147L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist