Provider Demographics
NPI:1265666374
Name:ANDERSON, MARCIE BETH (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:BETH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BROUWERS DR
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-2500
Mailing Address - Country:US
Mailing Address - Phone:724-537-6149
Mailing Address - Fax:724-537-6156
Practice Address - Street 1:500 BROUWERS DR
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-2500
Practice Address - Country:US
Practice Address - Phone:724-537-6149
Practice Address - Fax:724-537-6156
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008755235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist