Provider Demographics
NPI:1639964778
Name:MARTIN, KATHLEEN WARE (SLP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:WARE
Last Name:MARTIN
Suffix:
Gender:
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 ATLANTA HWY STE 701
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1255
Mailing Address - Country:US
Mailing Address - Phone:404-971-8031
Mailing Address - Fax:
Practice Address - Street 1:2450 ATLANTA HWY STE 701
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1255
Practice Address - Country:US
Practice Address - Phone:404-971-8031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP013528235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist