MEDICARE: KAYLA JEAN MARTIN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	69011	TX
2	1041C0700X	Clinical Social Worker	149.030273	IL
3	1041C0700X	Clinical Social Worker	LW61678234	WA

General Provider Information

NPI Number	:	1033802707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA JEAN MARTIN LCSW

Provider Business Mailing Address
First Line	:	8140 WALNUT HILL LN STE 440
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4396
Country	:	US
Telephone Number	:	469-709-9250
Fax Number	:

Provider Business Practice Location Address
First Line	:	4311 N RAVENSWOOD AVE STE 305
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1192
Country	:	US
Telephone Number	:	469-709-9250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2023
Last Update Date	:	05/22/2026

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