Provider Demographics
NPI:1447542931
Name:MARKS, MARLA JANE (MS/SLP)
Entity type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:JANE
Last Name:MARKS
Suffix:
Gender:F
Credentials:MS/SLP
Other - Prefix:MRS
Other - First Name:MARLA
Other - Middle Name:BLOOMFIELD
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS/SLP
Mailing Address - Street 1:3228 CORDOBA RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-3924
Mailing Address - Country:US
Mailing Address - Phone:561-715-8999
Mailing Address - Fax:
Practice Address - Street 1:3228 CORDOBA RANCH BLVD.
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559
Practice Address - Country:US
Practice Address - Phone:561-715-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9185235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist