Provider Demographics
NPI:1497033930
Name:MARTIN, MELANIE KATHARINE (TSLP)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:KATHARINE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:TSLP
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:KATHARINE
Other - Last Name:LLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1110 CALL CREEK DR STE 4B
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3072
Mailing Address - Country:US
Mailing Address - Phone:208-233-4660
Mailing Address - Fax:208-233-4262
Practice Address - Street 1:1110 CALL CREEK DR STE 4B
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3072
Practice Address - Country:US
Practice Address - Phone:208-233-4660
Practice Address - Fax:208-233-4262
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDTSLP-2126235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist