Doctor Name: | KELLY JEAN MARTIN |
NPI Number: | 1871878645 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. CCC-SLP |
License Number: | 002121 |
Business Practice Address: | 5264 Council St Ne Cedar Rapids, IA - 524022471 |
Business Phone Number: | 3199290500 |
Business Fax Number: | |
Mailing Address: | 5264 Council St Ne, CEDAR RAPIDS |
State: | IA |
Postal Code: | 524022471 |
Phone Number: | 3199290500 |
Fax Number: | |
NPI Enumeration Date: | 10/12/2011 |
NPI Last Update Date: | 09/28/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 002121 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
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 |