Provider Demographics
NPI:1598313751
Name:MARTINS, OLIVIA JANE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JANE
Last Name:MARTINS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9721 12TH PL SE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-1992
Mailing Address - Country:US
Mailing Address - Phone:617-610-6412
Mailing Address - Fax:
Practice Address - Street 1:12309 22ND ST NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-9500
Practice Address - Country:US
Practice Address - Phone:425-335-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60975968235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist