Provider Demographics
NPI:1891994604
Name:MARTINEZ, SHANA ERIN WEINREICH (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:ERIN WEINREICH
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 CHAMA AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-3600
Mailing Address - Country:US
Mailing Address - Phone:970-622-0302
Mailing Address - Fax:
Practice Address - Street 1:1711 CHAMA AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-3600
Practice Address - Country:US
Practice Address - Phone:970-622-0302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0296169231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist