Provider Demographics
NPI:1376670158
Name:MARKS, TINA MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:MARKS
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 1:11306 HIGHWAY 190
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-2419
Mailing Address - Country:US
Mailing Address - Phone:337-331-2096
Mailing Address - Fax:
Practice Address - Street 1:421 S 4TH ST
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5301
Practice Address - Country:US
Practice Address - Phone:337-331-4234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5058235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist