Provider Demographics
NPI:1679601785
Name:MARTIN, BARBARA MILLER (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:MILLER
Last Name:MARTIN
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 1:1853 HULL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-4462
Mailing Address - Country:US
Mailing Address - Phone:773-354-3621
Mailing Address - Fax:708-344-4049
Practice Address - Street 1:1853 HULL AVE
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-4462
Practice Address - Country:US
Practice Address - Phone:773-354-3621
Practice Address - Fax:708-344-4049
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist