Provider Demographics
NPI:1346040417
Name:MARCHACK, PATRICIA SUE (MS SLP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:SUE
Last Name:MARCHACK
Suffix:
Gender:
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 S WINDING TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-3119
Mailing Address - Country:US
Mailing Address - Phone:573-999-3670
Mailing Address - Fax:
Practice Address - Street 1:1818 W WORLEY ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-1038
Practice Address - Country:US
Practice Address - Phone:573-214-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003013351235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist