Provider Demographics
NPI:1134353386
Name:DUNKLE, MARGE H (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARGE
Middle Name:H
Last Name:DUNKLE
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 1:722 PINELLAS BAYWAY S
Mailing Address - Street 2:107
Mailing Address - City:TIERRA VERDE
Mailing Address - State:FL
Mailing Address - Zip Code:33715-1969
Mailing Address - Country:US
Mailing Address - Phone:727-804-1864
Mailing Address - Fax:
Practice Address - Street 1:722 PINELLAS BAYWAY S
Practice Address - Street 2:107
Practice Address - City:TIERRA VERDE
Practice Address - State:FL
Practice Address - Zip Code:33715-1969
Practice Address - Country:US
Practice Address - Phone:727-804-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-02
Last Update Date:2009-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 5019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist