Provider Demographics
NPI:1134565880
Name:MARTINEZ CLARK, ASHLEY CATHERINE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CATHERINE
Last Name:MARTINEZ CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2747 ENTERPRISE RD E UNIT 14
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1154
Mailing Address - Country:US
Mailing Address - Phone:201-660-0492
Mailing Address - Fax:
Practice Address - Street 1:1111 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4432
Practice Address - Country:US
Practice Address - Phone:727-446-0581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA21773235Z00000X
FLSZ10439235Z00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst