Provider Demographics
NPI:1407161193
Name:MARTIN, MISTY N (AUD, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:MISTY
Middle Name:N
Last Name:MARTIN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:N
Other - Last Name:RINGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD CCC-A
Mailing Address - Street 1:4191 BELLAIRE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1003
Mailing Address - Country:US
Mailing Address - Phone:713-790-1272
Mailing Address - Fax:
Practice Address - Street 1:4191 BELLAIRE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1003
Practice Address - Country:US
Practice Address - Phone:713-790-1272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0008268026237600000X
TX80738237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter