Provider Demographics
NPI:1982150488
Name:HIGGINSON, MARK (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HIGGINSON
Suffix:
Gender:M
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 1:2220 N CAMINO PRINCIPAL STE D
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-5305
Mailing Address - Country:US
Mailing Address - Phone:520-261-3306
Mailing Address - Fax:520-300-8092
Practice Address - Street 1:2220 N CAMINO PRINCIPAL STE D
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715
Practice Address - Country:US
Practice Address - Phone:505-399-1067
Practice Address - Fax:520-300-8092
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP10556235Z00000X
ND1530235Z00000X
AZSLP10556235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ03535Medicaid