Provider Demographics
NPI:1679601785
Name:MARTIN, BARBARA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 KEYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-2019
Mailing Address - Country:US
Mailing Address - Phone:773-354-3621
Mailing Address - Fax:708-719-8702
Practice Address - Street 1:111 KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-2019
Practice Address - Country:US
Practice Address - Phone:773-354-3621
Practice Address - Fax:708-719-8702
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-006612235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist