Provider Demographics
NPI:1235277906
Name:POWER, MARK (MA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:POWER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 QUAIL ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2730
Mailing Address - Country:US
Mailing Address - Phone:949-552-5523
Mailing Address - Fax:
Practice Address - Street 1:1400 QUAIL ST
Practice Address - Street 2:SUITE #252
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2730
Practice Address - Country:US
Practice Address - Phone:949-552-5523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP2790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP 2790OtherSPEECH PATHOLOGIST LICENSE