Provider Demographics
NPI:1093018624
Name:WALSH-AZIZ, MARCIA LYNN (SLP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:LYNN
Last Name:WALSH-AZIZ
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 1:2235 SYRACUSE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-3635
Mailing Address - Country:US
Mailing Address - Phone:815-954-4407
Mailing Address - Fax:
Practice Address - Street 1:2235 SYRACUSE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-3635
Practice Address - Country:US
Practice Address - Phone:815-954-4407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002286235Z00000X
IL146010340235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist