Provider Demographics
NPI:1861644478
Name:MARTINEZ, SUSAN J (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:J
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 1:801 HIDDEN VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5155
Mailing Address - Country:US
Mailing Address - Phone:765-277-6466
Mailing Address - Fax:866-785-4924
Practice Address - Street 1:1752 LLANFAIR AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-2961
Practice Address - Country:US
Practice Address - Phone:765-277-6466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003806A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12007679OtherASHA