Provider Demographics
NPI:1225116692
Name:MARTIN, LAURA SIMMONS (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SIMMONS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 TIMBER CREEK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4234
Mailing Address - Country:US
Mailing Address - Phone:901-309-5219
Mailing Address - Fax:901-309-5265
Practice Address - Street 1:146 TIMBER CREEK DR STE 101
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4234
Practice Address - Country:US
Practice Address - Phone:901-309-5219
Practice Address - Fax:901-309-5265
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2379235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4290424OtherBCBST PIN
TN4129036OtherBCBS OF TN
TN7698562OtherAETNA