Provider Demographics
NPI:1205855145
Name:WILCOX, MARC LUTHER (MS CCC-A)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:LUTHER
Last Name:WILCOX
Suffix:
Gender:M
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CENTRAL AVE
Mailing Address - Street 2:W123 THOMPSON HALL
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1127
Mailing Address - Country:US
Mailing Address - Phone:716-673-3203
Mailing Address - Fax:
Practice Address - Street 1:280 CENTRAL AVE
Practice Address - Street 2:W123 THOMPSON HALL
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1127
Practice Address - Country:US
Practice Address - Phone:716-673-3203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001310-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist