Provider Demographics
NPI:1275703704
Name:ANDERSON, MARCIA LEE (AUD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:LEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 ELLIOT RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1519
Mailing Address - Country:US
Mailing Address - Phone:516-641-5037
Mailing Address - Fax:516-466-3158
Practice Address - Street 1:600 NORTHERN BLVD
Practice Address - Street 2:SUITE 312
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5200
Practice Address - Country:US
Practice Address - Phone:516-641-5037
Practice Address - Fax:516-466-3158
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000110-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist