Provider Demographics
NPI:1568105112
Name:MARTELL, JULISSA ALEXANDRIA (BS ASST SLP)
Entity Type:Individual
Prefix:
First Name:JULISSA
Middle Name:ALEXANDRIA
Last Name:MARTELL
Suffix:
Gender:F
Credentials:BS ASST SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 CLOSNER ST
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-4505
Mailing Address - Country:US
Mailing Address - Phone:956-650-3336
Mailing Address - Fax:
Practice Address - Street 1:505 ANGELITA DR STE 16
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78599-8694
Practice Address - Country:US
Practice Address - Phone:956-969-5777
Practice Address - Fax:956-969-5775
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX420072355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty