| Doctor Name: | MRS. MARCIA DIANE CONLISK |
| NPI Number: | 1962845784 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S.CCC-SLP/L |
| License Number: | 146.004683 |
| Business Practice Address: | 215 E Washington St Pontiac, IL - 617642011 |
| Business Phone Number: | 8158446131 |
| Business Fax Number: | |
| Mailing Address: | 220 9th Ave, CHENOA |
| State: | IL |
| Postal Code: | 617261299 |
| Phone Number: | 2174189946 |
| Fax Number: | |
| NPI Enumeration Date: | 04/10/2013 |
| NPI Last Update Date: | 04/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 146.004683 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| 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 |