Provider Demographics
NPI:1487990933
Name:MARCUCCI, SIOBHAN C (SLP)
Entity type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:C
Last Name:MARCUCCI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 JOE DIMAGGIO BLVD STE 56
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-3996
Mailing Address - Country:US
Mailing Address - Phone:512-218-6955
Mailing Address - Fax:
Practice Address - Street 1:7112 ED BLUESTEIN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2913
Practice Address - Country:US
Practice Address - Phone:512-744-6000
Practice Address - Fax:512-583-5462
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207164901Medicaid
TX149984001Medicaid
TX676535Medicare PIN
TX149984001Medicaid