Provider Demographics
NPI:1689677734
Name:MARTIN, MELODY S (PHD, AUD, CCC-SP)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:S
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD, AUD, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 W WACO DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7016
Mailing Address - Country:US
Mailing Address - Phone:254-732-9741
Mailing Address - Fax:254-732-9745
Practice Address - Street 1:4720 W WACO DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7016
Practice Address - Country:US
Practice Address - Phone:254-732-9741
Practice Address - Fax:254-732-9745
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10287235Z00000X
TX50259231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089441202Medicaid
TX517068Medicare ID - Type UnspecifiedBC/BS - MEDICARE