Provider Demographics
NPI:1063068500
Name:CHAFFEE, MARLA
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:CHAFFEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29201 TELEGRAPH RD STE 500
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7648
Mailing Address - Country:US
Mailing Address - Phone:248-569-5985
Mailing Address - Fax:248-569-3704
Practice Address - Street 1:26850 PROVIDENCE PKWY STE 165
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1255
Practice Address - Country:US
Practice Address - Phone:248-569-5985
Practice Address - Fax:248-569-3704
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000846231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist