Provider Demographics
NPI:1356770135
Name:BUCK, MARTHA S (SLP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:S
Last Name:BUCK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 SW PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-3624
Mailing Address - Country:US
Mailing Address - Phone:360-807-7245
Mailing Address - Fax:360-748-8767
Practice Address - Street 1:1265 SW PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3624
Practice Address - Country:US
Practice Address - Phone:360-807-7245
Practice Address - Fax:360-748-8767
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60421799235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist