Provider Demographics
NPI:1245755438
Name:MARTINEZ, FELISA LOPEZ (SLP-A)
Entity Type:Individual
Prefix:
First Name:FELISA
Middle Name:LOPEZ
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 RACQUET CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6408
Mailing Address - Country:US
Mailing Address - Phone:682-738-3056
Mailing Address - Fax:682-738-3272
Practice Address - Street 1:3103 STRONG AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-3946
Practice Address - Country:US
Practice Address - Phone:817-404-9462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX398142355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant