Healthcare Provider Details

I. General information

NPI: 1730553702
Provider Name (Legal Business Name): AMBER JILL MARTINEZ M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMBER JILL PRENTICE M.S., CCC-SLP

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 LAND GRANT ST STE 250-1
ST AUGUSTINE FL
32092-1681
US

IV. Provider business mailing address

6505 SHILOH RD STE 100
ALPHARETTA GA
30005-1645
US

V. Phone/Fax

Practice location:
  • Phone: 904-886-3228
  • Fax:
Mailing address:
  • Phone: 678-648-7644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 15135
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP009559
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: