Provider Demographics
NPI:1295141240
Name:MARTINEZ, LEIGH (MS, CCC-SLP, BCBA)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 WALNEY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2285
Mailing Address - Country:US
Mailing Address - Phone:619-508-3145
Mailing Address - Fax:
Practice Address - Street 1:4530 WALNEY RD STE 105
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2285
Practice Address - Country:US
Practice Address - Phone:619-508-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000393103K00000X
VA2202004379235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty