Provider Demographics
NPI:1386115194
Name:MARTIN, ISABEL (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4703 RAVENSWOOD RD APT 18
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1155
Mailing Address - Country:US
Mailing Address - Phone:978-509-4966
Mailing Address - Fax:
Practice Address - Street 1:4703 RAVENSWOOD RD APT 18
Practice Address - Street 2:
Practice Address - City:RIVERDALE PARK
Practice Address - State:MD
Practice Address - Zip Code:20737-1155
Practice Address - Country:US
Practice Address - Phone:978-509-4966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08852235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty