Provider Demographics
NPI:1306671284
Name:MARCIAS, JONATHAN ANIBAL
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ANIBAL
Last Name:MARCIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-6015
Mailing Address - Country:US
Mailing Address - Phone:469-593-4904
Mailing Address - Fax:
Practice Address - Street 1:13900 ESPERANZA RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-3919
Practice Address - Country:US
Practice Address - Phone:469-593-4904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121545235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist