Individual
CHARLENE SAMONE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
103 DUE WEST PASS, DALLAS, GA 30157-2545
(404) 556-7053
Mailing address
103 DUE WEST PASS, DALLAS, GA 30157-2545
(404) 556-7053
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP007542
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10005249
AMERICAN SPEECH AND HEARING ASSOCIATION
GA
01
—
SLP007542
GEORGIA LICENSING ENTITY
GA
Enumeration date
07/15/2020
Last updated
10/20/2020
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