Provider Demographics
NPI:1205969136
Name:BROADWAY, MARCEL LEAH (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARCEL
Middle Name:LEAH
Last Name:BROADWAY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 CRESCENT CT W
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-3446
Mailing Address - Country:US
Mailing Address - Phone:610-820-7667
Mailing Address - Fax:
Practice Address - Street 1:3721 CRESCENT CT W
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-3446
Practice Address - Country:US
Practice Address - Phone:610-820-7667
Practice Address - Fax:610-820-7671
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003763L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019280600002Medicaid