Provider Demographics
NPI:1679118681
Name:NATERAS-DUENAS, MARCY (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:
Last Name:NATERAS-DUENAS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 W FARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-5606
Mailing Address - Country:US
Mailing Address - Phone:209-277-0469
Mailing Address - Fax:
Practice Address - Street 1:2265 W FARLINGTON ST
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-5606
Practice Address - Country:US
Practice Address - Phone:209-277-0469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28260235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist