Provider Demographics
NPI:1649585043
Name:MARKCITY, SUSAN AMANDA
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:AMANDA
Last Name:MARKCITY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 RUBY AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-3431
Mailing Address - Country:US
Mailing Address - Phone:775-527-4374
Mailing Address - Fax:
Practice Address - Street 1:865 RUBY AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-3431
Practice Address - Country:US
Practice Address - Phone:775-527-4374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2043062235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist