Provider Demographics
NPI:1518539634
Name:YONTZ, MARTIN FITZMAURICE (SLPA)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:FITZMAURICE
Last Name:YONTZ
Suffix:
Gender:M
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 E RAY RD UNIT 340
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-4516
Mailing Address - Country:US
Mailing Address - Phone:480-265-5557
Mailing Address - Fax:480-247-4311
Practice Address - Street 1:1425 W ELLIOT RD
Practice Address - Street 2:SUITE 203
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5129
Practice Address - Country:US
Practice Address - Phone:480-265-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA13123235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist