Provider Demographics
NPI:1609907443
Name:MYERS, MARTHA K (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:K
Last Name:MYERS
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 CAMP ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-2537
Mailing Address - Country:US
Mailing Address - Phone:504-899-4775
Mailing Address - Fax:504-899-4775
Practice Address - Street 1:4000 WEST ESPLANADE AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3073
Practice Address - Country:US
Practice Address - Phone:504-885-1606
Practice Address - Fax:504-885-2603
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2943235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist