Individual
MR. WILLIAM BRADLEY MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA CCC-SLP
Contact information
Practice address
1390 E 20TH ST, FARMINGTON, NM 87401-9037
(505) 599-8535
(505) 599-8536
Mailing address
1390 E 20TH ST, FARMINGTON, NM 87401-9037
(505) 599-8535
(505) 599-8536
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1425
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
K2563
—
NM
Enumeration date
04/03/2007
Last updated
07/09/2007
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