Provider Demographics
NPI:1629703681
Name:CRAIG, MARSHALL W
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:W
Last Name:CRAIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5124 SUMMERHILL RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-1824
Mailing Address - Country:US
Mailing Address - Phone:903-794-5839
Mailing Address - Fax:903-794-1686
Practice Address - Street 1:5124 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1824
Practice Address - Country:US
Practice Address - Phone:903-794-5839
Practice Address - Fax:903-794-1686
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80767237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist