Provider Demographics
NPI:1659602480
Name:PINZON, MARTHA YANEDT (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:YANEDT
Last Name:PINZON
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 1:11751 SW 235TH ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6026
Mailing Address - Country:US
Mailing Address - Phone:305-492-9627
Mailing Address - Fax:
Practice Address - Street 1:11751 SW 235TH ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:FL
Practice Address - Zip Code:33032-6026
Practice Address - Country:US
Practice Address - Phone:306-492-9627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-18
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FLSA14725235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002869100Medicaid