Provider Demographics
NPI:1679978282
Name:MARSH, TERRA I
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:
Last Name:MARSH
Suffix:I
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 1:602 BRODERICK ST
Mailing Address - Street 2:APT. 3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1439
Mailing Address - Country:US
Mailing Address - Phone:503-867-4499
Mailing Address - Fax:
Practice Address - Street 1:2528 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1614
Practice Address - Country:US
Practice Address - Phone:503-867-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8611235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist