Provider Demographics
NPI:1144382078
Name:MARTIN, ANITA SUE (MS CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:SUE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:SUE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7620 METCALF AVENUE
Mailing Address - Street 2:SUITE M
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2996
Mailing Address - Country:US
Mailing Address - Phone:913-383-9014
Mailing Address - Fax:913-383-9015
Practice Address - Street 1:7620 METCALF AVENUE
Practice Address - Street 2:SUITE M
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2996
Practice Address - Country:US
Practice Address - Phone:913-383-9014
Practice Address - Fax:913-383-9015
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2425235Z00000X
MO00612235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO33241011OtherBLUE CROSS BLUE SHIELD