Provider Demographics
NPI:1871330829
Name:MARTIN, TAMIKA JAVON (SLP-MA-CCC)
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:JAVON
Last Name:MARTIN
Suffix:
Gender:F
Credentials:SLP-MA-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 NW 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-3625
Mailing Address - Country:US
Mailing Address - Phone:951-999-1201
Mailing Address - Fax:
Practice Address - Street 1:201 LOGANS MANOR DR
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9739
Practice Address - Country:US
Practice Address - Phone:951-999-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13937235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist