Provider Demographics
NPI:1215099742
Name:MARTIN, PATRICIA (M S CCC SLP L)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:M S CCC SLP L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9519 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-9310
Mailing Address - Country:US
Mailing Address - Phone:708-479-2131
Mailing Address - Fax:708-479-7985
Practice Address - Street 1:9519 BIRCH AVE
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9310
Practice Address - Country:US
Practice Address - Phone:708-479-2131
Practice Address - Fax:708-479-7985
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist