Individual
ELEANOR TOUISELLE MARTINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
4107 LAFAYETTE BLVD, SUITE 3, FREDERICKSBURG, VA 22408-4266
(540) 220-7501
(540) 479-1422
Mailing address
320 TULIP PL, FREDERICKSBURG, VA 22408-1559
(703) 738-6472
(703) 652-5425
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202004561
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12040841
ASHA, AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
—
01
—
2202004561
BOARD OF AUDIOLOGY AND SPEECH-LANGUAGE PATHOLOGY
VA
Enumeration date
01/29/2007
Last updated
11/16/2011
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