Provider Demographics
NPI:1750434353
Name:ROSENTHAL, MARCIA GAIL (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:GAIL
Last Name:ROSENTHAL
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 1:10 SUNNY BANK ROAD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107
Mailing Address - Country:US
Mailing Address - Phone:207-767-2393
Mailing Address - Fax:
Practice Address - Street 1:10 SUNNY BANK ROAD
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107
Practice Address - Country:US
Practice Address - Phone:207-767-2393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1298 W235Z00000X
MESP1561235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASP0114OtherBLUE CROSS BLUE SHIELD
11457327OtherCAQH