Basic Information
| Provider Information | |||||||||
| NPI: | 1053854570 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | GEORGIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8937 SOUTHPOINTE DR STE A1 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462271087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178518419 | ||||||||
| FaxNumber: | 3178518499 | ||||||||
| Practice Location | |||||||||
| Address1: | 8937 SOUTHPOINTE DR STE A1 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462271087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178518419 | ||||||||
| FaxNumber: | 3178518499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2016 | ||||||||
| LastUpdateDate: | 12/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 22006252A | IN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.