Provider Demographics
NPI:1962709006
Name:NOODELL, MARCY (MS-CCC)
Entity type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:NOODELL
Suffix:
Gender:F
Credentials:MS-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20650 GLENN ST.
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-0439
Mailing Address - Country:US
Mailing Address - Phone:402-289-9045
Mailing Address - Fax:
Practice Address - Street 1:3220 SOUTH 188 AVENUE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2804
Practice Address - Country:US
Practice Address - Phone:402-289-9045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE511235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist