Provider Demographics
NPI:1639648025
Name:MARTIN, JENNY (MS, SLP-CFY)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS, SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13895 W WAINWRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5011
Mailing Address - Country:US
Mailing Address - Phone:208-939-3334
Mailing Address - Fax:
Practice Address - Street 1:13895 W WAINWRIGHT DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5011
Practice Address - Country:US
Practice Address - Phone:208-939-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist