Provider Demographics
NPI:1558701490
Name:MALDONADO, MARTHA YESENIA (SLP)
Entity Type:Individual
Prefix:MISS
First Name:MARTHA
Middle Name:YESENIA
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 N CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-8492
Mailing Address - Country:US
Mailing Address - Phone:956-750-1560
Mailing Address - Fax:
Practice Address - Street 1:208 W FERGUSON ST STE 3
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-2455
Practice Address - Country:US
Practice Address - Phone:956-258-5073
Practice Address - Fax:956-258-5333
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3230855605Medicaid