Provider Demographics
NPI:1780833988
Name:MARTIE, LYNN ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:ANN
Last Name:MARTIE
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 1:1201 N CUMMINGS LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-2181
Mailing Address - Country:US
Mailing Address - Phone:309-886-2305
Mailing Address - Fax:309-444-3893
Practice Address - Street 1:24588 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CHENOA
Practice Address - State:IL
Practice Address - Zip Code:61726-9395
Practice Address - Country:US
Practice Address - Phone:309-747-2702
Practice Address - Fax:309-747-5238
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146002354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL537460041OtherMEDICARE PTAN