Provider Demographics
NPI:1861236812
Name:NULL, MARCI SHANON
Entity type:Individual
Prefix:
First Name:MARCI
Middle Name:SHANON
Last Name:NULL
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 1:409 MESQUITE DR
Mailing Address - Street 2:
Mailing Address - City:RIO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:76093-3430
Mailing Address - Country:US
Mailing Address - Phone:817-933-8792
Mailing Address - Fax:
Practice Address - Street 1:409 MESQUITE DR
Practice Address - Street 2:
Practice Address - City:RIO VISTA
Practice Address - State:TX
Practice Address - Zip Code:76093-3430
Practice Address - Country:US
Practice Address - Phone:817-933-8792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX436192355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant