Provider Demographics
NPI:1700149986
Name:MARCHAND, MARY PETERSON (CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:PETERSON
Last Name:MARCHAND
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 1:415 MAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2223
Mailing Address - Country:US
Mailing Address - Phone:318-216-6125
Mailing Address - Fax:
Practice Address - Street 1:415 MAYFAIR DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2223
Practice Address - Country:US
Practice Address - Phone:318-216-6125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107837235Z00000X
LA2948235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist