Provider Demographics
NPI:1144210204
Name:FELSENFELD, MARK ALAN (MA CCC-SLP (SPEECH))
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALAN
Last Name:FELSENFELD
Suffix:
Gender:M
Credentials:MA CCC-SLP (SPEECH)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29915 MUIRLAND DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2050
Mailing Address - Country:US
Mailing Address - Phone:248-672-6109
Mailing Address - Fax:248-855-7669
Practice Address - Street 1:29915 MUIRLAND DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2050
Practice Address - Country:US
Practice Address - Phone:248-672-6109
Practice Address - Fax:248-855-7669
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00792770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist