Provider Demographics
NPI:1710476841
Name:MARTINEZ, HEATHER M (RBT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:M
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 HERON CIR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8888
Mailing Address - Country:US
Mailing Address - Phone:815-995-0025
Mailing Address - Fax:
Practice Address - Street 1:1014 HERON CIR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8888
Practice Address - Country:US
Practice Address - Phone:815-995-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician