Provider Demographics
NPI:1831493170
Name:MARSH, DANA ELAINE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:ELAINE
Last Name:MARSH
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 1:614 N ROCKINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8711
Mailing Address - Country:US
Mailing Address - Phone:417-827-8335
Mailing Address - Fax:888-527-0428
Practice Address - Street 1:614 N ROCKINGHAM AVE
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8711
Practice Address - Country:US
Practice Address - Phone:417-827-8335
Practice Address - Fax:888-527-0428
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005014042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist