Provider Demographics
NPI:1609803998
Name:ACLUCHE, MARIE KATIANA (MS)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:KATIANA
Last Name:ACLUCHE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 47 BOX 625
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09470
Mailing Address - Country:GB
Mailing Address - Phone:01144148-084-4521
Mailing Address - Fax:
Practice Address - Street 1:423 ABS/SGOH RAF ALCONBURY
Practice Address - Street 2:UNIT 5610 BOX 223
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09470
Practice Address - Country:GB
Practice Address - Phone:01144148-084-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7222235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist