Provider Demographics
NPI:1336449230
Name:MARTINEZ, VILMA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:VILMA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7810 34TH AVE APT 6I
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-2417
Mailing Address - Country:US
Mailing Address - Phone:646-229-9307
Mailing Address - Fax:
Practice Address - Street 1:7314 YELLOWSTONE BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4195
Practice Address - Country:US
Practice Address - Phone:718-896-1508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015501235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist