Provider Demographics
NPI:1942815899
Name:MARTINEZ-SIERRA, INEZ
Entity Type:Individual
Prefix:
First Name:INEZ
Middle Name:
Last Name:MARTINEZ-SIERRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 DAVID CT UNIT D
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-7875
Mailing Address - Country:US
Mailing Address - Phone:630-785-8261
Mailing Address - Fax:
Practice Address - Street 1:2100 MANCHESTER RD STE 602
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4587
Practice Address - Country:US
Practice Address - Phone:630-480-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178015586101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE