Provider Demographics
NPI:1750741682
Name:MARTENS, SHERI (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:
Last Name:MARTENS
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73737-2110
Mailing Address - Country:US
Mailing Address - Phone:580-227-2531
Mailing Address - Fax:
Practice Address - Street 1:408 E BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OK
Practice Address - Zip Code:73737-2110
Practice Address - Country:US
Practice Address - Phone:580-227-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK192235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist