Provider Demographics
NPI:1235566589
Name:MIKE-COURY, MARION ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARION
Middle Name:ANN
Last Name:MIKE-COURY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8502
Mailing Address - Country:US
Mailing Address - Phone:714-834-1111
Mailing Address - Fax:
Practice Address - Street 1:2121 S TOWNE CENTRE PL
Practice Address - Street 2:SUITE 370
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-6122
Practice Address - Country:US
Practice Address - Phone:714-922-4453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP21022235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist