Provider Demographics
NPI:1891755807
Name:WEEKS, MARK (MCD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:WEEKS
Suffix:
Gender:M
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N ROOP ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-4739
Mailing Address - Country:US
Mailing Address - Phone:775-885-9888
Mailing Address - Fax:775-885-7961
Practice Address - Street 1:408 N ROOP ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-4739
Practice Address - Country:US
Practice Address - Phone:775-885-9888
Practice Address - Fax:775-885-7961
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV04-01333231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002313002Medicaid
NV003413002Medicaid
NVV559178761Medicare PIN