Provider Demographics
NPI:1346871548
Name:MARTINEZ, TERESA MARIA (SLPA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21620 N 19TH AVE STE A6
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2716
Mailing Address - Country:US
Mailing Address - Phone:602-875-5616
Mailing Address - Fax:
Practice Address - Street 1:21620 N 19TH AVE STE A6
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2716
Practice Address - Country:US
Practice Address - Phone:602-875-5616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11559235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist