Provider Demographics
NPI:1013270271
Name:MARTINEZ, KRISTIN PREUSS (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:PREUSS
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1600
Mailing Address - Country:US
Mailing Address - Phone:970-817-0902
Mailing Address - Fax:
Practice Address - Street 1:1736 CONCORD DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1600
Practice Address - Country:US
Practice Address - Phone:970-817-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12150135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist