Provider Demographics
NPI:1679055461
Name:MARTINEAU, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MARTINEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 143
Mailing Address - Street 2:
Mailing Address - City:GLENBROOK
Mailing Address - State:NV
Mailing Address - Zip Code:89413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1711 LOGAN CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:GLENBROOK
Practice Address - State:NV
Practice Address - Zip Code:89413
Practice Address - Country:US
Practice Address - Phone:925-487-7656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist