Provider Demographics
NPI:1689666208
Name:MARTIN, TERRY (MS, CCC-A)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W COLUMBIA ST
Mailing Address - Street 2:SUITE #300
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1782
Mailing Address - Country:US
Mailing Address - Phone:812-425-1500
Mailing Address - Fax:812-425-0587
Practice Address - Street 1:350 W COLUMBIA ST
Practice Address - Street 2:SUITE #300
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1782
Practice Address - Country:US
Practice Address - Phone:812-425-1500
Practice Address - Fax:812-425-0587
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23000631A231H00000X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000084021OtherANTHEM BLUECROSS BLUESHIE
IN000000084021OtherANTHEM BLUECROSS BLUESHIE