Provider Demographics
NPI:1790087476
Name:THOMPSON-MARTINEZ, JENIFER LYN
Entity Type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:LYN
Last Name:THOMPSON-MARTINEZ
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 1:3166 EAST PALMDALE BLVD SUITE 112
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550
Mailing Address - Country:US
Mailing Address - Phone:661-274-8454
Mailing Address - Fax:661-274-7614
Practice Address - Street 1:3166 E PALMDALE BLVD STE 112
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-5038
Practice Address - Country:US
Practice Address - Phone:661-274-8454
Practice Address - Fax:661-274-7614
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist