Provider Demographics
NPI:1154557346
Name:HORWITZ, MARK M (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:M
Last Name:HORWITZ
Suffix:
Gender:M
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 1:425 GLEN ECHO RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2915
Mailing Address - Country:US
Mailing Address - Phone:215-500-6445
Mailing Address - Fax:
Practice Address - Street 1:425 GLEN ECHO RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2915
Practice Address - Country:US
Practice Address - Phone:215-500-6445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL 010720235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist