Provider Demographics
NPI:1285960310
Name:MARTINA, JULIE M (SLP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:MARTINA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14517 25TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5792
Mailing Address - Country:US
Mailing Address - Phone:425-520-3415
Mailing Address - Fax:425-367-0553
Practice Address - Street 1:722 AVENUE D
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2365
Practice Address - Country:US
Practice Address - Phone:425-520-3415
Practice Address - Fax:425-367-0553
Is Sole Proprietor?:No
Enumeration Date:2009-10-24
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60116479235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7018518Medicaid
WA7018518Medicaid