Provider Demographics
NPI:1629234877
Name:DOE, MARTA A (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:A
Last Name:DOE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 W PLATH AVE
Mailing Address - Street 2:#2
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-5249
Mailing Address - Country:US
Mailing Address - Phone:509-945-6005
Mailing Address - Fax:
Practice Address - Street 1:5001 STATESMAN DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2414
Practice Address - Country:US
Practice Address - Phone:877-282-5613
Practice Address - Fax:877-508-1628
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60025574235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7980709Medicaid
WA506506OtherMEDICARE SPEECH