Provider Demographics
NPI:1710084280
Name:MARTIN, BOBBI (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS,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:P.O. BOX 980
Mailing Address - Street 2:
Mailing Address - City:LONOKE
Mailing Address - State:AR
Mailing Address - Zip Code:72086
Mailing Address - Country:US
Mailing Address - Phone:501-676-2786
Mailing Address - Fax:501-676-0697
Practice Address - Street 1:518 NE FRONT STREET
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086
Practice Address - Country:US
Practice Address - Phone:501-676-2786
Practice Address - Fax:501-676-0697
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#996235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist