Provider Demographics
NPI:1154674182
Name:MORDEN, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MORDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 CHRISTY WAY S
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2225
Mailing Address - Country:US
Mailing Address - Phone:989-799-6603
Mailing Address - Fax:
Practice Address - Street 1:3120 CHRISTY WAY S
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2225
Practice Address - Country:US
Practice Address - Phone:989-799-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501006676237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3501006676OtherLICENSE