Provider Demographics
NPI:1831619154
Name:MARTIN, WILLIAM JOHN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOHN
Last Name:MARTIN
Suffix:
Gender:M
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 1:703 BOGGS AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15211-2317
Mailing Address - Country:US
Mailing Address - Phone:724-464-8604
Mailing Address - Fax:
Practice Address - Street 1:703 BOGGS AVENUE, APT. 3
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15211
Practice Address - Country:US
Practice Address - Phone:724-464-8604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013122235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty