Provider Demographics
NPI:1578707519
Name:MARTIN, ANNE MARIE ROSE (SLP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE ROSE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 NIKODEM LN
Mailing Address - Street 2:
Mailing Address - City:ABRAMS
Mailing Address - State:WI
Mailing Address - Zip Code:54101-9581
Mailing Address - Country:US
Mailing Address - Phone:920-826-6456
Mailing Address - Fax:
Practice Address - Street 1:100 E HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1001
Practice Address - Country:US
Practice Address - Phone:920-848-3272
Practice Address - Fax:920-330-0278
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3211-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist