Provider Demographics
NPI:1730434234
Name:MARTIN MATT, JENNIFER M (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MARTIN MATT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2180 NORTH LOOP W STE 160
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-8001
Mailing Address - Country:US
Mailing Address - Phone:281-684-1818
Mailing Address - Fax:832-200-2266
Practice Address - Street 1:2180 NORTH LOOP W STE 160
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-8001
Practice Address - Country:US
Practice Address - Phone:832-831-0043
Practice Address - Fax:832-200-2266
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1700254653OtherGROUP NPI
TX321950301Medicaid
TX321950301Medicaid