Provider Demographics
NPI:1023388147
Name:MARQUIS-SERSON, ALICIA ANN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:ANN
Last Name:MARQUIS-SERSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 KYSERIKE ROAD
Mailing Address - Street 2:
Mailing Address - City:STONE RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12484
Mailing Address - Country:US
Mailing Address - Phone:845-687-2400
Mailing Address - Fax:
Practice Address - Street 1:122 KYSERIKE ROAD
Practice Address - Street 2:
Practice Address - City:STONE RIDGE
Practice Address - State:NY
Practice Address - Zip Code:12484
Practice Address - Country:US
Practice Address - Phone:845-687-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016814235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist