Provider Demographics
NPI:1104540046
Name:WRIGHT, MARCIA ELISE (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:ELISE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 COOK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-1115
Mailing Address - Country:US
Mailing Address - Phone:281-498-8100
Mailing Address - Fax:
Practice Address - Street 1:4250 COOK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-1115
Practice Address - Country:US
Practice Address - Phone:281-498-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15123235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0657199-01Medicaid