Healthcare Provider Details

I. General information

NPI: 1821949694
Provider Name (Legal Business Name): MARTIN SPEECH AND MYO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 WOODFIELD DR STE 122
SAVOY IL
61874-9505
US

IV. Provider business mailing address

114 E WALNUT ST
TEUTOPOLIS IL
62467-1154
US

V. Phone/Fax

Practice location:
  • Phone: 217-249-8181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TRACI MARTIN
Title or Position: SOLE MEMBER/SLP
Credential: CCC-SLP
Phone: 720-545-8160