Provider Demographics
NPI:1730553702
Name:MARTINEZ, AMBER JILL (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:JILL
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:JILL
Other - Last Name:PRENTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:13325 SW 112TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-4456
Mailing Address - Country:US
Mailing Address - Phone:305-775-1493
Mailing Address - Fax:
Practice Address - Street 1:250 LAND GRANT ST STE 250-1
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-1681
Practice Address - Country:US
Practice Address - Phone:904-886-3228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009559235Z00000X
FLSA 15135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist