Individual
MARY A MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
101 E MILLER RD, STERLING, IL 61081-1252
(815) 625-4790
Mailing address
101 E MILLER RD, STERLING, IL 61081-1252
(815) 625-4790
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
072693
HEALTH ALLIANCE PLAN
IL
01
—
9815737
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/19/2006
Last updated
07/08/2007
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