Provider Demographics
NPI:1366847618
Name:MARTIN, ANGELA LEE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LEE
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 1:3240 BANNING RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-5207
Mailing Address - Country:US
Mailing Address - Phone:513-923-1000
Mailing Address - Fax:
Practice Address - Street 1:3240 BANNING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-5207
Practice Address - Country:US
Practice Address - Phone:513-923-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 7817235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist