Provider Demographics
NPI:1922557925
Name:MARTINEZ, MICHELLE LYNN
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:ZAKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLPA
Mailing Address - Street 1:9330 BROADWAY ST STE 312
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7895
Mailing Address - Country:US
Mailing Address - Phone:832-856-6241
Mailing Address - Fax:
Practice Address - Street 1:9330 BROADWAY ST STE 312
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7895
Practice Address - Country:US
Practice Address - Phone:832-856-6241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-02
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
TX404332355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other