Provider Demographics
NPI:1093992737
Name:FINK, MARSHA SMITH (MS CCCL SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:SMITH
Last Name:FINK
Suffix:
Gender:F
Credentials:MS CCCL SLP
Other - Prefix:MISS
Other - First Name:MARSHA
Other - Middle Name:ANN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCCL SLP
Mailing Address - Street 1:2407 S KANAWHA ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801
Mailing Address - Country:US
Mailing Address - Phone:304-253-2407
Mailing Address - Fax:304-253-9787
Practice Address - Street 1:105 ADAIR ST
Practice Address - Street 2:RALEIGH CO BOARD OF EDUCATION
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-256-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP 0150235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0152779000Medicaid