Provider Demographics
NPI:1609976851
Name:MARTIN, APRIL (MSP,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSP,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 PONDEROSA RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-8588
Mailing Address - Country:US
Mailing Address - Phone:843-430-9685
Mailing Address - Fax:
Practice Address - Street 1:190 RIVER PARK DR
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-6844
Practice Address - Country:US
Practice Address - Phone:843-741-0082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3865235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0334Medicaid
SCGP0334Medicaid