Healthcare Provider Details

I. General information

NPI: 1548662562
Provider Name (Legal Business Name): CHRISTINA M. MARTINI SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA M. PARENTI SLP

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 N WASHINGTON ST
JANESVILLE WI
53548-2907
US

IV. Provider business mailing address

557 N WASHINGTON ST
JANESVILLE WI
53548-2907
US

V. Phone/Fax

Practice location:
  • Phone: 608-754-6000
  • Fax: 608-755-7892
Mailing address:
  • Phone: 608-754-6000
  • Fax: 608-755-7892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146-012857
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242003203
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4268-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: