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General NPI Number Information
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NPI Number | 1912268608
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Entity Type | Individual
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Provider Name | JANE MARIE MARTINEZ BCBA
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Gender | Female
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 1211 21ST AVE S STE 110
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City | NASHVILLE
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State | TN
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Zip | 37212-2717
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Country | US
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Telephone | 937-478-2339
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Fax |
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Provider Business Mailing Address
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Address Line | 1211 21ST AVE S STE 110
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City | NASHVILLE
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State | TN
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Zip | 37212-2717
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Country | US
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Telephone | 937-478-2339
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | LBA0000000423
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number | LBA0000000423
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License Number State | TN
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