Provider Demographics
NPI:1982931267
Name:MARTIN, JETTE ROCHELLE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JETTE
Middle Name:ROCHELLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 N DELAWARE ST APT 503
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2473
Mailing Address - Country:US
Mailing Address - Phone:317-364-0284
Mailing Address - Fax:
Practice Address - Street 1:2010 N CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1222
Practice Address - Country:US
Practice Address - Phone:317-924-5821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-07
Last Update Date:2009-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004923A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist