Provider Demographics
NPI:1235275405
Name:MARTINO, ELEANOR TOUISELLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:TOUISELLE
Last Name:MARTINO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:ELEANOR
Other - Middle Name:TOUISELLE
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 TULIP PL
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-1559
Mailing Address - Country:US
Mailing Address - Phone:703-738-6472
Mailing Address - Fax:703-652-5425
Practice Address - Street 1:4107 LAFAYETTE BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4266
Practice Address - Country:US
Practice Address - Phone:540-220-7501
Practice Address - Fax:540-479-1422
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004561235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12040841OtherASHA, AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
VA2202004561OtherBOARD OF AUDIOLOGY AND SPEECH-LANGUAGE PATHOLOGY