Provider Demographics
NPI:1275688715
Name:KLENKE, MARSHA LYNN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:LYNN
Last Name:KLENKE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:MO
Mailing Address - Zip Code:63334-2046
Mailing Address - Country:US
Mailing Address - Phone:573-324-3962
Mailing Address - Fax:
Practice Address - Street 1:700 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-2046
Practice Address - Country:US
Practice Address - Phone:573-324-3962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002011887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1275688715OtherNPI