Provider Demographics
NPI:1447737853
Name:ALCIATI, MARK A (MSCCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:ALCIATI
Suffix:
Gender:M
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 CIENEGUITAS RD APT E
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1138
Mailing Address - Country:US
Mailing Address - Phone:805-450-1498
Mailing Address - Fax:
Practice Address - Street 1:736 CIENEGUITAS RD APT E
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1138
Practice Address - Country:US
Practice Address - Phone:805-450-1498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9157235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty