Provider Demographics
NPI:1366163412
Name:MARTINEZ, MICHELLE RENEE (SLPA)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:RENEE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:753 NW FORT SILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-5421
Mailing Address - Country:US
Mailing Address - Phone:580-248-6161
Mailing Address - Fax:580-585-6427
Practice Address - Street 1:753 NW FORT SILL BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-5421
Practice Address - Country:US
Practice Address - Phone:580-248-6161
Practice Address - Fax:580-585-6427
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant