Provider Demographics
NPI:1194933101
Name:MARTELL, HEIDI JO (MSCCCSLP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:JO
Last Name:MARTELL
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 SPRUCE CIR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-1642
Mailing Address - Country:US
Mailing Address - Phone:608-848-4037
Mailing Address - Fax:
Practice Address - Street 1:636 SPRUCE CIR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1642
Practice Address - Country:US
Practice Address - Phone:608-848-4037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2303154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist