Provider Demographics
NPI:1295910123
Name:MARTIN, STEPHANIE ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:ANNE
Other - Last Name:TARRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:983 NW SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-2111
Mailing Address - Country:US
Mailing Address - Phone:541-753-2068
Mailing Address - Fax:541-753-5392
Practice Address - Street 1:983 NW SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-2111
Practice Address - Country:US
Practice Address - Phone:541-753-2068
Practice Address - Fax:541-753-5392
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR30611231H00000X, 235Z00000X
ORHAS P 10119028237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR214452Medicaid