Provider Demographics
NPI:1316010762
Name:PODWALL, MARCIA (MS)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:PODWALL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 JERICHO TURNPIKE SUITE 103
Mailing Address - Street 2:SYOSSET SPEECH & HEARING CENTER
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791
Mailing Address - Country:US
Mailing Address - Phone:516-364-1234
Mailing Address - Fax:516-364-3132
Practice Address - Street 1:175 JERICHO TURNPIKE SUITE 103
Practice Address - Street 2:SYOSSET SPEECH & HEARING CENTER
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791
Practice Address - Country:US
Practice Address - Phone:516-364-1234
Practice Address - Fax:516-364-3132
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist