Doctor Name: | KATHLEEN ANNE MARTIN |
NPI Number: | 1073649224 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MACCCSLP |
License Number: | 01510 |
Business Practice Address: | 2652 S Wallis Smith Blvd Springfield, MO - 658043864 |
Business Phone Number: | 4174290404 |
Business Fax Number: | |
Mailing Address: | 2652 S Wallis Smith Blvd, SPRINGFIELD |
State: | MO |
Postal Code: | 658043864 |
Phone Number: | 4174290404 |
Fax Number: | |
NPI Enumeration Date: | 02/24/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 01510 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |