Provider Demographics
NPI:1508452749
Name:MARTIN, NICOLE A (SLPA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8898 SE PINE CONE LN
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-4442
Mailing Address - Country:US
Mailing Address - Phone:561-660-4936
Mailing Address - Fax:
Practice Address - Street 1:8898 SE PINE CONE LN
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-4442
Practice Address - Country:US
Practice Address - Phone:561-660-4936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL46552355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant