Provider Demographics
NPI:1992988067
Name:MARTIN, SALLY A (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N POPLAR ST
Mailing Address - Street 2:DEPARTMENT OF SPECIAL SERVICES
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-2322
Mailing Address - Country:US
Mailing Address - Phone:501-771-8039
Mailing Address - Fax:
Practice Address - Street 1:2200 N POPLAR ST
Practice Address - Street 2:DEPARTMENT OF SPECIAL SERVICES
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2322
Practice Address - Country:US
Practice Address - Phone:501-771-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1578235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist