Provider Demographics
NPI:1184766651
Name:MARTIN, ANITA (MSP CCCSLP)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSP CCCSLP
Other - Prefix:MRS
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:PIERRE-LOUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSP CCC-SLP
Mailing Address - Street 1:1000 WORTHINGTON TRAIL
Mailing Address - Street 2:APT 14206
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174
Mailing Address - Country:US
Mailing Address - Phone:931-334-5456
Mailing Address - Fax:
Practice Address - Street 1:2110 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2208
Practice Address - Country:US
Practice Address - Phone:931-455-5189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000003372235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist