Provider Demographics
NPI:1932579059
Name:MARTINO, HEIDI (SLP)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:MARTINO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5866 MORNINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3507
Mailing Address - Country:US
Mailing Address - Phone:301-788-5330
Mailing Address - Fax:410-442-9783
Practice Address - Street 1:2700 SPARTAN RD
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1500
Practice Address - Country:US
Practice Address - Phone:240-722-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist