Jennifer I Martin, MA; CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Bloomfield, NM
NPI 1992070775 · NPPES record last updated Mar 13, 2012
Key facts
- NPI
- 1992070775
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 1426 (NM)
- Practice address
- 325 N Bergin LN
Bloomfield, NM 87413-6729 - Phone
- (505) 632-4389
- Fax
- (505) 632-4371
- NPI assigned
- Mar 13, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1426 | NM | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Martin Therapy Services, LLC | Speech-Language Pathologist | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 1426 | NM | Yes |
Addresses
Primary practice location
325 N Bergin LN
Bloomfield, NM 87413-6729
Mailing address
325 N Bergin LN
Bloomfield, NM 87413-6729
Phone (505) 632-4389
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000K7825 | Medicaid | NM | |
| 064434826 | Medicaid | NM |
Other providers in Bloomfield, NM
- Michael Kurita
- Mariah Kay Lasley-Miller
- Marichu Lazo
- Kerriann Maria Malott
- Kylie Spencer Mangan
- Darlene M Martinez
- Amy Elizabeth Massey
- Randy R Maxson
- Cynthia L Miller
- Cortney Dawn Miner Preator
All providers in Bloomfield, NM · Speech-Language Pathologist in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.