Provider Demographics
NPI:1659657930
Name:FISH, MARIANNE MACHALA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:MACHALA
Last Name:FISH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42536 HAYES RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6766
Mailing Address - Country:US
Mailing Address - Phone:586-286-9644
Mailing Address - Fax:586-286-9647
Practice Address - Street 1:42536 HAYES RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6766
Practice Address - Country:US
Practice Address - Phone:586-286-9644
Practice Address - Fax:586-286-9647
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist