Provider Demographics
NPI:1174019301
Name:ENSLEY, MARTHA BUIE (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:BUIE
Last Name:ENSLEY
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 1:6600 FINGERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-9771
Mailing Address - Country:US
Mailing Address - Phone:980-621-9616
Mailing Address - Fax:
Practice Address - Street 1:211 W MATTHEWS ST
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1309
Practice Address - Country:US
Practice Address - Phone:704-846-0262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3580235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist