Provider Demographics
NPI:1629556592
Name:MARQUETTE UNIVERSITY
Entity Type:Organization
Organization Name:MARQUETTE UNIVERSITY
Other - Org Name:MARQUETTE UNIVERSITY-SPEECH PATHOLOGY & AUDIOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:DEAN OF COLLEGE OF HEALTH SCIENCES4
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:CULLINAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-288-5053
Mailing Address - Street 1:604 N 16TH ST RM 223
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2117
Mailing Address - Country:US
Mailing Address - Phone:414-288-7426
Mailing Address - Fax:414-288-3980
Practice Address - Street 1:604 N 16TH ST RM 223
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2117
Practice Address - Country:US
Practice Address - Phone:414-288-7426
Practice Address - Fax:414-288-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty