Provider Demographics
NPI:1710524210
Name:MARTINEZ, MALORIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MALORIE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 TALBOT BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-3000
Mailing Address - Country:US
Mailing Address - Phone:410-778-8150
Mailing Address - Fax:
Practice Address - Street 1:201 TALBOT BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-3000
Practice Address - Country:US
Practice Address - Phone:410-778-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD04059OtherSTATE OF MD DEPARTMENT OF HEALTH AUD, HAD & SPEECH-LANG PATHOLOGISTS
12010637OtherASHA - AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION