Provider Demographics
NPI:1497180970
Name:MARTINKO, ELLERY CAITLIN
Entity Type:Individual
Prefix:MISS
First Name:ELLERY
Middle Name:CAITLIN
Last Name:MARTINKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 RIVER RUN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4902
Mailing Address - Country:US
Mailing Address - Phone:419-512-7555
Mailing Address - Fax:
Practice Address - Street 1:1470 WARREN RD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3918
Practice Address - Country:US
Practice Address - Phone:216-529-4254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP10578235Z00000X
OHSP-10578235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist