Individual
MISS BROOKE F MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
830 NE 47TH AVE, PORTLAND, OR 97213-2212
(503) 215-2278
(503) 215-2478
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
15572
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500719144
—
OR
Enumeration date
08/10/2016
Last updated
03/14/2018
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