Provider Demographics
NPI:1285986554
Name:MARTINEZ, SUMMER V (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:V
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials: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:PO BOX 3307
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-3307
Mailing Address - Country:US
Mailing Address - Phone:903-753-8499
Mailing Address - Fax:
Practice Address - Street 1:1249 COUNTY ROAD 184
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633-5324
Practice Address - Country:US
Practice Address - Phone:903-753-8499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101782235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist