Provider Demographics
NPI:1568465995
Name:MARTIN, BOBETTE S (MA,CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:BOBETTE
Middle Name:S
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5658 HIGHWAY 260
Mailing Address - Street 2:STE 4
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-5189
Mailing Address - Country:US
Mailing Address - Phone:928-537-7373
Mailing Address - Fax:928-537-7377
Practice Address - Street 1:5658 HIGHWAY 260
Practice Address - Street 2:STE 4
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-5189
Practice Address - Country:US
Practice Address - Phone:928-537-7373
Practice Address - Fax:928-537-7377
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA 898231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ562670Medicaid
AZR10712Medicare UPIN