Provider Demographics
NPI:1124410907
Name:HOUGHTON, MARIE (MS CCC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:HOUGHTON
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CASHEL DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-4134
Mailing Address - Country:US
Mailing Address - Phone:309-912-6445
Mailing Address - Fax:
Practice Address - Street 1:16 CASHEL DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-4134
Practice Address - Country:US
Practice Address - Phone:309-912-6445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009822235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist