Provider Demographics
NPI:1477780088
Name:WILEY, MARCIA LEA (MS)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:LEA
Last Name:WILEY
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 1:2412 SAINT FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-7233
Mailing Address - Country:US
Mailing Address - Phone:337-217-4300
Mailing Address - Fax:337-217-4303
Practice Address - Street 1:2412 SAINT FRANCIS ST
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-7233
Practice Address - Country:US
Practice Address - Phone:337-217-4300
Practice Address - Fax:337-217-4303
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2814235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist