Provider Demographics
NPI:1508279480
Name:MARTIN, ANGELA (SLP-ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 MEADOWMERE LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-6544
Mailing Address - Country:US
Mailing Address - Phone:817-525-5522
Mailing Address - Fax:
Practice Address - Street 1:4775 NORTH FWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76106-2300
Practice Address - Country:US
Practice Address - Phone:682-738-3056
Practice Address - Fax:682-738-3272
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX378972355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant