Provider Demographics
NPI:1619530128
Name:MARTINES, ANNIE ROSE (CF-SLP)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:ROSE
Last Name:MARTINES
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:ROSE
Other - Last Name:MARTINES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11160 HURON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3335
Mailing Address - Country:US
Mailing Address - Phone:720-872-6472
Mailing Address - Fax:
Practice Address - Street 1:11160 HURON ST STE 200
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-3335
Practice Address - Country:US
Practice Address - Phone:720-872-6472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14145110235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14145110OtherASHA