Provider Demographics
NPI:1831215805
Name:MARTINO, AMANDA L (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:MARTINO
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:STJEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:50 SPINNAKER LN
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-8595
Mailing Address - Country:US
Mailing Address - Phone:401-225-7852
Mailing Address - Fax:
Practice Address - Street 1:10 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-6716
Practice Address - Country:US
Practice Address - Phone:401-826-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00908235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist