Provider Demographics
NPI:1932478153
Name:MARQUES, KHALILAH MIGNON (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KHALILAH
Middle Name:MIGNON
Last Name:MARQUES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9957 MOORINGS DR STE 301
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-2415
Mailing Address - Country:US
Mailing Address - Phone:904-652-6165
Mailing Address - Fax:833-241-4607
Practice Address - Street 1:9957 MOORINGS DR STE 301
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-2415
Practice Address - Country:US
Practice Address - Phone:904-652-6165
Practice Address - Fax:833-241-4607
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18647235Z00000X
GASLP011016235Z00000X
FLSA11658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist