Provider Demographics
NPI:1407230568
Name:RUDNICK, MARCIA ELLEN
Entity Type:Individual
Prefix:MISS
First Name:MARCIA
Middle Name:ELLEN
Last Name:RUDNICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE HEIDELBERG DRIVE
Mailing Address - Street 2:
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565
Mailing Address - Country:US
Mailing Address - Phone:610-927-8160
Mailing Address - Fax:
Practice Address - Street 1:ONE HEIDELBERG DRIVE
Practice Address - Street 2:
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565
Practice Address - Country:US
Practice Address - Phone:610-927-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000221L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist