Provider Demographics
NPI:1356517759
Name:SIVISKI, MARSHA TITCOMB (MA,CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:TITCOMB
Last Name:SIVISKI
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 BABBIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2404
Mailing Address - Country:US
Mailing Address - Phone:207-797-0877
Mailing Address - Fax:
Practice Address - Street 1:77 BABBIDGE RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2404
Practice Address - Country:US
Practice Address - Phone:207-797-0877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP313235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist