Provider Demographics
NPI:1457090185
Name:MARTIN, DAWN WALLACE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:WALLACE
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 1:4030 GLEN HOLLOW CT NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-8786
Mailing Address - Country:US
Mailing Address - Phone:828-228-7090
Mailing Address - Fax:
Practice Address - Street 1:1350 OBRIAN DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3858
Practice Address - Country:US
Practice Address - Phone:828-352-3440
Practice Address - Fax:828-465-7326
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4635235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist