Provider Demographics
NPI:1710492020
Name:MARTINEZ, ELISA (SLP ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:SLP ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 VILLAGE WAY APT 2312
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-2934
Mailing Address - Country:US
Mailing Address - Phone:956-393-8046
Mailing Address - Fax:
Practice Address - Street 1:7120 VILLAGE WAY APT 2312
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-2934
Practice Address - Country:US
Practice Address - Phone:956-393-8046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant