Provider Demographics
NPI:1205104759
Name:MARTINEZ, LORI RENEE (SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:RENEE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 BEAUMONT DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2515
Mailing Address - Country:US
Mailing Address - Phone:515-827-1996
Mailing Address - Fax:
Practice Address - Street 1:86 BEAUMONT DR
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-2515
Practice Address - Country:US
Practice Address - Phone:515-827-1996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007455-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist