Provider Demographics
NPI:1609106921
Name:CAIN, MARCIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:
Last Name:CAIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 S US HIGHWAY 1
Mailing Address - Street 2:APT. S4A
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-8436
Mailing Address - Country:US
Mailing Address - Phone:607-382-2088
Mailing Address - Fax:
Practice Address - Street 1:1605 S US HIGHWAY 1
Practice Address - Street 2:APT. S4A
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-8436
Practice Address - Country:US
Practice Address - Phone:607-382-2088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10214235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist