Provider Demographics
NPI:1770605792
Name:MARTENS, KAREN MARIE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MARIE
Last Name:MARTENS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 CRESCENT RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-9588
Mailing Address - Country:US
Mailing Address - Phone:812-256-5543
Mailing Address - Fax:812-256-5543
Practice Address - Street 1:3911 CRESCENT RD
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-9588
Practice Address - Country:US
Practice Address - Phone:812-256-5543
Practice Address - Fax:812-256-5543
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004335A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist