Provider Demographics
NPI:1881967578
Name:MARTIN, ROSEMARIE (MHS CCC, SLP/L-IL)
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MHS CCC, SLP/L-IL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MARAY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1919
Mailing Address - Country:US
Mailing Address - Phone:708-473-5196
Mailing Address - Fax:815-485-0397
Practice Address - Street 1:129 MARAY AVE
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-1919
Practice Address - Country:US
Practice Address - Phone:708-473-5196
Practice Address - Fax:815-485-0397
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-11
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL242002255OtherSTATE LICENSE