Provider Demographics
NPI:1477323632
Name:DART, MARTHA (MCD, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:DART
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 RUE WELLER
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-2347
Mailing Address - Country:US
Mailing Address - Phone:985-789-3101
Mailing Address - Fax:
Practice Address - Street 1:21 INDUSTRIAL PARK BLVD BLDG A
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-8303
Practice Address - Country:US
Practice Address - Phone:720-423-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24433927235Z00000X
LA9695235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist