Mattie Malloy Marks, M.ED. CF-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

60772408 Issued in WA

Practice address

10605 Carter St SE
Yelm, WA 98597-8486

Phone

(360) 458-6020

NPI assigned

Dec 7, 2017

Last updated

Dec 7, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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  • NPI 1578082954

  Speech-Language Pathologist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512604800000",
    "number": "1376058669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1695 SEQUALITCHEW DR UNIT 102",
            "city": "DUPONT",
            "state": "WA",
            "postal_code": "983276837",
            "telephone_number": "678-790-0933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10605 CARTER ST SE",
            "city": "YELM",
            "state": "WA",
            "postal_code": "985978486",
            "telephone_number": "360-458-6020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARKS",
        "first_name": "MATTIE",
        "middle_name": "MALLOY",
        "credential": "M.ED. CF-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-07",
        "last_updated": "2017-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "60772408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON DEPARTMENT OF HEALTH",
            "identifier": "60772408",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathy Lund, LMP
• Lucian Leila Lyons-Bridges, LMP
• Rachel Malmgren, SLP-CCC
• Justin Mandeville, PA-C
• Jonalyn Labrica Marelic, LMP
• Crystal Martin, DC
• Celina Martinez
• Amy Ashton Masters
• Kathleen J May, F.N.P.
• Janina Camille McGill, D.M.D.

• Speech-Language Pathologist in Yelm, WA
• Providers in Yelm, WA by specialty
• Speech-Language Pathologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.