Basic Information
| Provider Information | |||||||||
| NPI: | 1457829772 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCRAE | ||||||||
| FirstName: | MARISSA | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21605 SUPERIOR RD | ||||||||
| Address2: | |||||||||
| City: | TAYLOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481804752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139999943 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1660 FORT ST | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481832003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343044159 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2018 | ||||||||
| LastUpdateDate: | 07/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7101004909 | MI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.