Provider Demographics
NPI:1619489325
Name:CUPP, MARKI LYNN
Entity Type:Individual
Prefix:
First Name:MARKI
Middle Name:LYNN
Last Name:CUPP
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 1:4657 SIERRA VISTA AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-8525
Mailing Address - Country:US
Mailing Address - Phone:909-349-5895
Mailing Address - Fax:
Practice Address - Street 1:4657 SIERRA VISTA AVE APT 207
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-8525
Practice Address - Country:US
Practice Address - Phone:909-349-5895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41292355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant