Provider Demographics
NPI:1154878056
Name:MARTIN, MILLICENT FRANCES (AUD)
Entity type:Individual
Prefix:DR
First Name:MILLICENT
Middle Name:FRANCES
Last Name:MARTIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MILLICENT
Other - Middle Name:FRANCES
Other - Last Name:MUNITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2298 OCEAN HWY W
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-4024
Mailing Address - Country:US
Mailing Address - Phone:910-755-6923
Mailing Address - Fax:
Practice Address - Street 1:2298 OCEAN HWY W
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4024
Practice Address - Country:US
Practice Address - Phone:910-755-6923
Practice Address - Fax:910-755-6923
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
098231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist