Provider Demographics
NPI:1326298928
Name:VANRYCKEGHEM, MARTINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTINE
Middle Name:
Last Name:VANRYCKEGHEM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 BENTLEY GREEN CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4349
Mailing Address - Country:US
Mailing Address - Phone:407-365-4117
Mailing Address - Fax:
Practice Address - Street 1:12424 RESEARCH PKWY
Practice Address - Street 2:SUITE 155
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-3249
Practice Address - Country:US
Practice Address - Phone:407-882-0268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist