Provider Demographics
NPI:1306126008
Name:MARTINEZ, LISA YVONNE (MSCCCSLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:YVONNE
Last Name:MARTINEZ
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 1:1337 GUSDORF RD STE G
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6297
Mailing Address - Country:US
Mailing Address - Phone:575-758-4337
Mailing Address - Fax:575-751-1890
Practice Address - Street 1:2400 LAKEVIEW DR
Practice Address - Street 2:STE. 102
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1532
Practice Address - Country:US
Practice Address - Phone:806-468-9400
Practice Address - Fax:806-468-9401
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105423235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist