Provider Demographics
NPI:1043756190
Name:CHAMBERLAIN, MARTHA ALEXANDRA
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ALEXANDRA
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:ALEXANDRA
Other - Last Name:CAVAZOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7801 N LAMAR BLVD STE A114
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1049
Mailing Address - Country:US
Mailing Address - Phone:512-646-4673
Mailing Address - Fax:512-729-0320
Practice Address - Street 1:7801 N LAMAR BLVD STE A114
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1049
Practice Address - Country:US
Practice Address - Phone:512-646-4673
Practice Address - Fax:512-729-0320
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11310235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist