Provider Demographics
NPI:1619181146
Name:MARSOLLIER, NIVES FEMOPASE
Entity Type:Individual
Prefix:
First Name:NIVES
Middle Name:FEMOPASE
Last Name:MARSOLLIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5752 W COMET AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-1308
Mailing Address - Country:US
Mailing Address - Phone:623-931-4323
Mailing Address - Fax:
Practice Address - Street 1:10730 W CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5400
Practice Address - Country:US
Practice Address - Phone:623-772-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1243235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist