Provider Demographics
NPI:1083949796
Name:MONDELL, MARTHA ANN (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
Last Name:MONDELL
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:MARTI
Other - Middle Name:
Other - Last Name:MONDELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5065 SW 40TH PLACE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474
Mailing Address - Country:US
Mailing Address - Phone:352-266-3706
Mailing Address - Fax:
Practice Address - Street 1:1601 NE 25TH AVE
Practice Address - Street 2:SUITE NUMBER 900
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-8800
Practice Address - Country:US
Practice Address - Phone:352-629-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2556235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist