Provider Demographics
NPI:1821667486
Name:INGE, MARIE CAMILLE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:CAMILLE
Last Name:INGE
Suffix:
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 1:6002 LLANO AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-6322
Mailing Address - Country:US
Mailing Address - Phone:251-382-5600
Mailing Address - Fax:
Practice Address - Street 1:6002 LLANO AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-6322
Practice Address - Country:US
Practice Address - Phone:251-382-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118289235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist