Healthcare Provider Details

I. General information

NPI: 1992807622
Provider Name (Legal Business Name): CHRISTINE MARTIN M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE BUTH M.A., CCC-SLP

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST
MIAMI FL
33136-2107
US

IV. Provider business mailing address

1120 NW 14TH ST
MIAMI FL
33136-2107
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-9975
  • Fax: 305-243-1651
Mailing address:
  • Phone: 305-243-9975
  • Fax: 305-243-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146000525
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA21357
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: