Provider Demographics
NPI:1801647771
Name:MARTINEZ, GUADALUPE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 W MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-4851
Mailing Address - Country:US
Mailing Address - Phone:847-924-2886
Mailing Address - Fax:
Practice Address - Street 1:17366 W GAGES LAKE RD
Practice Address - Street 2:
Practice Address - City:GAGES LAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1831
Practice Address - Country:US
Practice Address - Phone:847-984-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14395263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist