Healthcare Provider Details

I. General information

NPI: 1275011504
Provider Name (Legal Business Name): CHRISTINA XIDAS MARTIN MS, SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 RATHMELL RD
COLUMBUS OH
43207-4737
US

IV. Provider business mailing address

745 RATHMELL RD
COLUMBUS OH
43207-4737
US

V. Phone/Fax

Practice location:
  • Phone: 614-491-8044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.13590
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCOND.2018749-SP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: