Provider Demographics
NPI:1023194362
Name:JAMES, MARK S (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:JAMES
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 S MARYLAND PKWY
Mailing Address - Street 2:STE A-5 #469
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7146
Mailing Address - Country:US
Mailing Address - Phone:702-401-4017
Mailing Address - Fax:702-616-2526
Practice Address - Street 1:9850 S MARYLAND PKWY
Practice Address - Street 2:STE A-5 #469
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-7146
Practice Address - Country:US
Practice Address - Phone:702-401-4017
Practice Address - Fax:702-616-2526
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-774235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503403Medicaid