Individual
JENNIFER I MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA; CCC-SLP
Contact information
Practice address
325 N BERGIN LN, BLOOMFIELD, NM 87413-6729
(505) 632-4389
(505) 632-4371
Mailing address
325 N BERGIN LN, BLOOMFIELD, NM 87413-6729
(505) 632-4389
(505) 632-4371
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1426
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000K7825
—
NM
05
—
064434826
—
NM
Enumeration date
03/13/2012
Last updated
03/13/2012
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