Provider Demographics
NPI:1770029258
Name:WEISS, MARCY MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:MARIE
Last Name:WEISS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MARCY
Other - Middle Name:MARIE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3108 ENCINO AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-2750
Mailing Address - Country:US
Mailing Address - Phone:361-945-2699
Mailing Address - Fax:
Practice Address - Street 1:3108 ENCINO AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-2750
Practice Address - Country:US
Practice Address - Phone:361-945-2699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP-1380235Z00000X
TX112774235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist