Provider Demographics
NPI:1861222390
Name:MARK, VANESSA I
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:I
Last Name:MARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 MAINSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1201
Mailing Address - Country:US
Mailing Address - Phone:606-618-9381
Mailing Address - Fax:
Practice Address - Street 1:160 S HOLLYWOOD ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-4801
Practice Address - Country:US
Practice Address - Phone:901-416-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist