Provider Demographics
NPI:1073945481
Name:MARSHALL, ALETHEA STBERNARD (MSED TSHH)
Entity Type:Individual
Prefix:
First Name:ALETHEA
Middle Name:STBERNARD
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MSED TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 E 94TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-2024
Mailing Address - Country:US
Mailing Address - Phone:646-261-3418
Mailing Address - Fax:
Practice Address - Street 1:984 E 94TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-2024
Practice Address - Country:US
Practice Address - Phone:646-261-3418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4154OtherEARLY INTERVENTION STATE ID#4154