Provider Demographics
NPI:1467747758
Name:BREWER, MARTHA BATES (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:BATES
Last Name:BREWER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:DIANE
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:492 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-8030
Mailing Address - Country:US
Mailing Address - Phone:828-279-6949
Mailing Address - Fax:
Practice Address - Street 1:492 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-8030
Practice Address - Country:US
Practice Address - Phone:828-279-6949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS4265235Z00000X
AL5260235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05850766Medicaid