Provider Demographics
NPI:1134655301
Name:MARTINEZ, DAWN NICOLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:NICOLE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:ORACLE
Mailing Address - State:AZ
Mailing Address - Zip Code:85623-0355
Mailing Address - Country:US
Mailing Address - Phone:520-603-7987
Mailing Address - Fax:
Practice Address - Street 1:930 N SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:ORACLE
Practice Address - State:AZ
Practice Address - Zip Code:85623-0355
Practice Address - Country:US
Practice Address - Phone:520-603-7987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP 8444235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist