Provider Demographics
NPI:1790455772
Name:MARTINEZ, LIZETTE LIZCANO (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:LIZETTE
Middle Name:LIZCANO
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:MS
Other - First Name:LIZETTE
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2014 FAIR OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-2000
Mailing Address - Country:US
Mailing Address - Phone:956-249-0007
Mailing Address - Fax:
Practice Address - Street 1:615 W ELDORA RD
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-8073
Practice Address - Country:US
Practice Address - Phone:956-354-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109568235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist