MEDICARE: JACALYN MARTINEZ M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP.0002375	CO

General Provider Information

NPI Number	:	1114541059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACALYN MARTINEZ M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	140 W 29TH ST # 254
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81008-1002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 W D ST STE 100C
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-4430
Country	:	US
Telephone Number	:	719-621-1182
Fax Number	:	719-931-5601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2020
Last Update Date	:	04/09/2026

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Directions to “ JACALYN MARTINEZ M.S. CCC-SLP” Practice Location

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