Provider Demographics
NPI:1669723011
Name:DUQUE, MARTHA EUGENIA (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:EUGENIA
Last Name:DUQUE
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 1:58 CALLE SOCORRO
Mailing Address - Street 2:PMB 75
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-1854
Mailing Address - Country:US
Mailing Address - Phone:787-362-9672
Mailing Address - Fax:
Practice Address - Street 1:20 CALLE CORONEL
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-4800
Practice Address - Country:US
Practice Address - Phone:787-362-9672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR965235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist