Provider Demographics
NPI:1942086459
Name:MARTINEZ, MEG ANN (MA)
Entity Type:Individual
Prefix:MS
First Name:MEG
Middle Name:ANN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:OJO CALIENTE
Mailing Address - State:NM
Mailing Address - Zip Code:87549-0251
Mailing Address - Country:US
Mailing Address - Phone:505-692-5742
Mailing Address - Fax:
Practice Address - Street 1:1574 NM 502
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-2697
Practice Address - Country:US
Practice Address - Phone:505-692-5742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSAH-2023-0034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist