Provider Demographics
NPI:1013160720
Name:MARKS, SHANNAN BOYLE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNAN
Middle Name:BOYLE
Last Name:MARKS
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 1:465 AUTUMN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3611
Mailing Address - Country:US
Mailing Address - Phone:985-792-4596
Mailing Address - Fax:
Practice Address - Street 1:465 AUTUMN CREEK DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-3611
Practice Address - Country:US
Practice Address - Phone:985-792-4596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist