Provider Demographics
NPI:1124533302
Name:MARTELLARO, KENDRA MICHELE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:MICHELE
Last Name:MARTELLARO
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 1:2382 S KENTON ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1717
Mailing Address - Country:US
Mailing Address - Phone:303-263-9398
Mailing Address - Fax:
Practice Address - Street 1:900 POTOMAC ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6716
Practice Address - Country:US
Practice Address - Phone:303-695-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-09
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26739235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist