Provider Demographics
NPI:1770175051
Name:MARTIN, ELIZABETH LYONS (MA CCCSLP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:LYONS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-1604
Mailing Address - Country:US
Mailing Address - Phone:413-399-9080
Mailing Address - Fax:
Practice Address - Street 1:28 EVERETT ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1604
Practice Address - Country:US
Practice Address - Phone:916-769-7929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9632261QH0700X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech