Basic Information
| Provider Information | |||||||||
| NPI: | 1831215805 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINO | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.S.,CCC-SLP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | STJEAN | ||||||||
| OtherFirstName: | AMANDA | ||||||||
| OtherMiddleName: | L | ||||||||
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| OtherCredential: | M.S., CCC-SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 50 SPINNAKER LN | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028868595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012257852 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10 WOODLAND DR | ||||||||
| Address2: | |||||||||
| City: | COVENTRY | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028166716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018262000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 03/09/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP00908 | RI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.