Provider Demographics
NPI:1134439805
Name:MARTINEZ, VANESSA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:SANTIAGO-MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1242 SW PINE ISLAND RD
Mailing Address - Street 2:STE 42 #441
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991
Mailing Address - Country:US
Mailing Address - Phone:239-763-0353
Mailing Address - Fax:
Practice Address - Street 1:7750 W 26 AVE.
Practice Address - Street 2:#2
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-231-1276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10912235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist