Provider Demographics
NPI:1104041953
Name:NEEDLES, MARITA
Entity Type:Individual
Prefix:
First Name:MARITA
Middle Name:
Last Name:NEEDLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KENCREST SERVICES
Mailing Address - Street 2:502 W GERMANTOWN PIKE, SUITE 200
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462
Mailing Address - Country:US
Mailing Address - Phone:610-825-9360
Mailing Address - Fax:610-825-2414
Practice Address - Street 1:KENCREST SERVICES
Practice Address - Street 2:502 W GERMANTOWN PIKE, SUITE 200
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462
Practice Address - Country:US
Practice Address - Phone:610-825-9360
Practice Address - Fax:610-825-2414
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL002737L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101509136001OtherMA