Provider Demographics
NPI:1134530322
Name:ANDERSON, MARTHA LYNN (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:M.
Other - Middle Name:LYNN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1780 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2065
Mailing Address - Country:US
Mailing Address - Phone:303-250-7062
Mailing Address - Fax:
Practice Address - Street 1:7935 E PRENTICE AVE
Practice Address - Street 2:SUITE 104W
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2708
Practice Address - Country:US
Practice Address - Phone:303-756-0282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-11
Last Update Date:2014-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO83235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist