1730553702 NPI number — AMBER JILL MARTINEZ M.S., CCC-SLP

NPI Number: 1730553702
Health Care Provider/Practitioner: AMBER JILL MARTINEZ M.S., CCC-SLP

NPI Number : 1730553702 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730553702",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MARTINEZ",
    "FirstName": "AMBER",
    "MiddleName": "JILL",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.S., CCC-SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PRENTICE",
    "OtherFirstName": "AMBER",
    "OtherMiddleName": "JILL",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "M.S., CCC-SLP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "6505 SHILOH RD STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ALPHARETTA",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30005-1645",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "678-648-7644",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "250 LAND GRANT ST STE 250-1",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ST AUGUSTINE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32092-1681",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "904-886-3228",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/13/2015",
    "LastUpdateDate": "11/06/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "SA 15135",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "SLP009559",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}