Provider Demographics
NPI:1780836288
Name:GINSBERG, MARC EVAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:EVAN
Last Name:GINSBERG
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22198 CLOCKTOWER WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4640
Mailing Address - Country:US
Mailing Address - Phone:561-883-8863
Mailing Address - Fax:561-218-0485
Practice Address - Street 1:22198 CLOCKTOWER WAY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-4640
Practice Address - Country:US
Practice Address - Phone:561-883-8863
Practice Address - Fax:561-218-0485
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3884235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist