MEDICARE: SAMANTHA JO MARTINEZ M.A., 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	114551	TX

General Provider Information

NPI Number	:	1730723065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA JO MARTINEZ M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	19179 BLANCO RD STE 105
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4009
Country	:	US
Telephone Number	:	210-256-9859
Fax Number	:

Provider Business Practice Location Address
First Line	:	21811 HYERWOOD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-2156
Country	:	US
Telephone Number	:	210-256-9859
Fax Number	:

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

Provider Enumeration Date	:	10/30/2019
Last Update Date	:	07/05/2022

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