Provider Demographics
NPI:1497388615
Name:TRAYWICK, MARCIA DAWN (SLP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:DAWN
Last Name:TRAYWICK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 TIMBER RIDGE BAY DR
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-8797
Mailing Address - Country:US
Mailing Address - Phone:269-569-2157
Mailing Address - Fax:
Practice Address - Street 1:7783 BOWERS HARBOR AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9332
Practice Address - Country:US
Practice Address - Phone:269-598-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty