1043549926 NPI number — JANNETTE JOSEPHINE MARTIN MA, CCC

Table of content: JANNETTE JOSEPHINE MARTIN MA, CCC (NPI 1043549926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043549926 NPI number — JANNETTE JOSEPHINE MARTIN MA, CCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
JANNETTE
Provider Middle Name:
JOSEPHINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, CCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TURK
Provider Other First Name:
JANETTE
Provider Other Middle Name:
JOSEPHINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, CCC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1043549926
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7475 W 5TH AVE
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80226-1649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-987-1285
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7475 W 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80226-1649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-987-1285
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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