Provider Demographics
NPI:1932555786
Name:VERBRUGGEN, MARTHA PAULIN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:PAULIN
Last Name:VERBRUGGEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:MARTHA
Other - Middle Name:LETICIA
Other - Last Name:PAULIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:3322 GREYSTONE WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-7421
Mailing Address - Country:US
Mailing Address - Phone:229-469-6932
Mailing Address - Fax:229-469-6933
Practice Address - Street 1:3322 GREYSTONE WAY
Practice Address - Street 2:SUITE B
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-7421
Practice Address - Country:US
Practice Address - Phone:229-469-6932
Practice Address - Fax:229-469-6933
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009208235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist