Provider Demographics
NPI:1861914244
Name:MARTINEZ, ALEJANDRA FABIAN (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALEJANDRA
Middle Name:FABIAN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 W 22ND PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-3517
Mailing Address - Country:US
Mailing Address - Phone:773-968-3458
Mailing Address - Fax:
Practice Address - Street 1:2646 W. 22ND PLACE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:ID
Practice Address - Zip Code:60608
Practice Address - Country:US
Practice Address - Phone:773-968-3458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146013821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist