Provider Demographics
NPI:1558365338
Name:MARQUIS-COLVARD, CLARISSA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:
Last Name:MARQUIS-COLVARD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N OREGON ST
Mailing Address - Street 2:STE 420
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3351
Mailing Address - Country:US
Mailing Address - Phone:915-533-1388
Mailing Address - Fax:915-533-2933
Practice Address - Street 1:1900 N OREGON ST
Practice Address - Street 2:STE 420
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3351
Practice Address - Country:US
Practice Address - Phone:915-533-1388
Practice Address - Fax:915-533-2933
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004145101Medicaid