Doctor Name: | ISIASHA MARK |
NPI Number: | 1174992762 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 5862 |
Business Practice Address: | 714 S Lake Dr Suite 150 Lexington, SC - 290723462 |
Business Phone Number: | 8033564782 |
Business Fax Number: | 8039964782 |
Mailing Address: | 7828 Charles Towne Dr, COLUMBIA |
State: | SC |
Postal Code: | 292093010 |
Phone Number: | 3362604571 |
Fax Number: | |
NPI Enumeration Date: | 09/24/2015 |
NPI Last Update Date: | 09/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 5862 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |