Provider Demographics
NPI:1306391826
Name:MARTIN, KATHRYN (MACCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18199 COOK AVE
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-5216
Mailing Address - Country:US
Mailing Address - Phone:440-572-7000
Mailing Address - Fax:
Practice Address - Street 1:9306 PRIEM RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44149-2026
Practice Address - Country:US
Practice Address - Phone:440-572-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP11636235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist