Provider Demographics
NPI:1144483264
Name:MARTIN, JANICE LOUISE (MS-CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:LOUISE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 SPRING ST NE
Mailing Address - Street 2:REGAIN PROGRAM OF NORTHEAST GA MEDICAL CENTER
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3715
Mailing Address - Country:US
Mailing Address - Phone:770-533-8251
Mailing Address - Fax:770-538-3862
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:NORTHEAST GA MEDICAL CENTER
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-533-8251
Practice Address - Fax:770-538-3862
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003796235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist