MEDICARE: MICHELLE L MARTIN MS, CCC-SLP

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	235Z00000X	Speech-Language Pathologist	242001415	IL
2	235Z00000X	Speech-Language Pathologist	SLP.0001425	CO

General Provider Information

NPI Number	:	1578899787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE L MARTIN MS, CCC-SLP

Provider Business Mailing Address
First Line	:	1109 MARION ST #9
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218
Country	:	US
Telephone Number	:	414-202-1998
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 MARION ST #9
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218
Country	:	US
Telephone Number	:	414-202-1998
Fax Number	:

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

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	08/09/2013

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