Individual
MRS. GENNIFER MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
720 N MAIN AVE, REPUBLIC, MO 65738-1010
(417) 732-3670
Mailing address
1151 E CAMBRIDGE ST, SPRINGFIELD, MO 65807-3709
(316) 200-4547
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2008035479
MO
235Z00000X
Speech-Language Pathologist
2729
KS
Other
Enumeration date
09/14/2010
Last updated
09/14/2010
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