Provider Demographics
NPI:1689777500
Name:MARTINEZ, MARY HELEN (MA, SLP/CCC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:HELEN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MA, SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:166 BARBARA BND
Mailing Address - Street 2:APT/SUITE
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3602
Mailing Address - Country:US
Mailing Address - Phone:210-508-5298
Mailing Address - Fax:
Practice Address - Street 1:1248 AUSTIN HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4821
Practice Address - Country:US
Practice Address - Phone:210-646-8008
Practice Address - Fax:210-646-8242
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX14576235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86087TOtherBCBS
TX75285003678239A002OtherTRICARE