1659657930 NPI number — MS. MARIANNE MACHALA FISH M.S., CCC-SLP

Table of content: MS. MARIANNE MACHALA FISH M.S., CCC-SLP (NPI 1659657930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659657930 NPI number — MS. MARIANNE MACHALA FISH M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISH
Provider First Name:
MARIANNE
Provider Middle Name:
MACHALA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659657930
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42536 HAYES RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CLINTON TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48038-6766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-286-9644
Provider Business Mailing Address Fax Number:
586-286-9647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42536 HAYES RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CLINTON TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48038-6766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-286-9644
Provider Business Practice Location Address Fax Number:
586-286-9647
Provider Enumeration Date:
10/31/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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