Provider Demographics
NPI:1518500131
Name:MARTINO, ALISON (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:MARTINO
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 1:832 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2408
Mailing Address - Country:US
Mailing Address - Phone:609-752-1780
Mailing Address - Fax:
Practice Address - Street 1:147 E OLIVE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3407
Practice Address - Country:US
Practice Address - Phone:626-355-1729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-27
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09086235Z00000X
CA33572235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist