Provider Demographics
NPI:1750930236
Name:MARTIN, JENNIFER L (CF-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 CROWNE CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-6473
Mailing Address - Country:US
Mailing Address - Phone:407-497-7710
Mailing Address - Fax:
Practice Address - Street 1:542 ALLRED MILL RD
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2202
Practice Address - Country:US
Practice Address - Phone:336-789-5076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist