Provider Demographics
NPI:1881998151
Name:MARTINEZ, ANDREA LEA (SLP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:B
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:7733 FORSYTH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1817
Mailing Address - Country:US
Mailing Address - Phone:314-863-7422
Mailing Address - Fax:
Practice Address - Street 1:9505 NORTHPOINTE BLVD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3799
Practice Address - Country:US
Practice Address - Phone:281-569-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16562235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist