Provider Demographics
NPI:1659990166
Name:AMANDA E. MARTIN PLLC
Entity Type:Organization
Organization Name:AMANDA E. MARTIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:936-637-9195
Mailing Address - Street 1:15873 COUNTY ROAD 472
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75706-4043
Mailing Address - Country:US
Mailing Address - Phone:936-637-9195
Mailing Address - Fax:
Practice Address - Street 1:2808 S MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-7854
Practice Address - Country:US
Practice Address - Phone:936-637-9195
Practice Address - Fax:903-881-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty