Provider Demographics
NPI:1083773337
Name:MARTIN, ANN L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-2114
Mailing Address - Country:US
Mailing Address - Phone:541-504-8970
Mailing Address - Fax:541-504-5805
Practice Address - Street 1:124 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2114
Practice Address - Country:US
Practice Address - Phone:541-504-8970
Practice Address - Fax:541-504-5805
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR33651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1083773337OtherNPI
OR500777269Medicaid