Provider Demographics
NPI:1578855938
Name:HERZOG, MARGARET ANNE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:ANNE
Last Name:HERZOG
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 STATE ST APT 16
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2848
Mailing Address - Country:US
Mailing Address - Phone:814-455-2398
Mailing Address - Fax:
Practice Address - Street 1:2380 VILLAGE COMMON DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4980
Practice Address - Country:US
Practice Address - Phone:814-455-2398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009693235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist