Provider Demographics
NPI:1720346489
Name:MARTIN, MS, CCC-SLP, PARKER ANN (SLP)
Entity Type:Individual
Prefix:MISS
First Name:PARKER
Middle Name:ANN
Last Name:MARTIN, MS, CCC-SLP
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:PO BOX 23956
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33307
Mailing Address - Country:US
Mailing Address - Phone:954-249-2430
Mailing Address - Fax:954-947-6199
Practice Address - Street 1:4500 NORTH FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:954-249-2430
Practice Address - Fax:954-947-6199
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FLSA15518235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA15518OtherSPEECH LANGUAGE PATHOLOGIST
FL018911400Medicaid