Provider Demographics
NPI:1417131673
Name:PARKER, MARTHA V (CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:V
Last Name:PARKER
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 PINEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-6821
Mailing Address - Country:US
Mailing Address - Phone:910-690-9598
Mailing Address - Fax:
Practice Address - Street 1:57 PINEBROOK DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-6821
Practice Address - Country:US
Practice Address - Phone:910-690-9598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1143235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist