Provider Demographics
NPI:1003153016
Name:NELSON, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 CLEVELAND MASSILLON RD
Mailing Address - Street 2:STE 7A
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-5614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3725 CLEVELAND MASSILLON RD
Practice Address - Street 2:STE 7A
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-5614
Practice Address - Country:US
Practice Address - Phone:330-706-0446
Practice Address - Fax:330-706-0465
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2744237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist