Provider Demographics
NPI:1932492360
Name:MARX, NICOLE (MHS CCC SLP/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MARX
Suffix:
Gender:F
Credentials:MHS CCC SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1018
Mailing Address - Country:US
Mailing Address - Phone:773-233-7855
Mailing Address - Fax:
Practice Address - Street 1:2145 W 95TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1018
Practice Address - Country:US
Practice Address - Phone:773-233-7855
Practice Address - Fax:773-233-7858
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010636235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist