Provider Demographics
NPI:1508107335
Name:UTTER, MARCEY GABRIELLE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARCEY
Middle Name:GABRIELLE
Last Name:UTTER
Suffix:
Gender:F
Credentials:MS CCC-SLP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:79440 CORPORATE CENTER DR
Mailing Address - Street 2:SUITE 113
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-7241
Mailing Address - Country:US
Mailing Address - Phone:760-564-4726
Mailing Address - Fax:760-564-4728
Practice Address - Street 1:79440 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 113
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-7241
Practice Address - Country:US
Practice Address - Phone:760-564-4726
Practice Address - Fax:760-564-4728
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9417235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist