Provider Demographics
NPI:1225548977
Name:HAXER, MARC JOSEPH
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:JOSEPH
Last Name:HAXER
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 1:5333 MCAULEY DR RM 2017
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1096
Mailing Address - Country:US
Mailing Address - Phone:734-434-3200
Mailing Address - Fax:734-434-3209
Practice Address - Street 1:5333 MCAULEY DR RM 2017
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1096
Practice Address - Country:US
Practice Address - Phone:734-434-3200
Practice Address - Fax:734-434-3209
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101003010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist