Active NPI
Kym Erin Martin, MA CCC-SLP
- Speech-Language Pathologist
- Surprise, AZ
National Provider Identifier
1104964832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP4166
- Practice address
- 15526 N 164TH LN
Surprise, AZ 85388-1107 - Phone
- (623) 229-8574
- NPI assigned
- Feb 2, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP4166 | AZ | Primary |
Addresses
Primary practice location
15526 N 164TH LN
Surprise, AZ 85388-1107
Mailing address
215 W Portland St Unit 246C
Phoenix, AZ 85003-5429
Phone (623) 229-8574
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 643040 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP4166 | AZ | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235952000000",
"number": "1104964832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 W PORTLAND ST UNIT 246C",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850035429",
"telephone_number": "623-229-8574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15526 N 164TH LN",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "853881107",
"telephone_number": "623-229-8574"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "KYM",
"middle_name": "ERIN",
"name_prefix": "Miss",
"credential": "MA CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-02",
"last_updated": "2009-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AZ",
"license": "SLP4166",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "643040",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Surprise, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.