Healthcare Provider Details

I. General information

NPI: 1366350886
Provider Name (Legal Business Name): AVERY SPANGLER MARTIN M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 WOLVERINE DR
QUITMAN LA
71268-4402
US

IV. Provider business mailing address

387 JOE SHOVAN RD
QUITMAN LA
71268-1052
US

V. Phone/Fax

Practice location:
  • Phone: 318-259-2698
  • Fax:
Mailing address:
  • Phone: 318-548-4463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9941
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: