Basic Information
| Provider Information | |||||||||
| NPI: | 1861919995 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTONE | ||||||||
| FirstName: | LENA | ||||||||
| MiddleName: | ROSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3126 S EAGLE TER | ||||||||
| Address2: | |||||||||
| City: | INVERNESS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344507479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522010411 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11565 HARTS RD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322183777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047511834 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2017 | ||||||||
| LastUpdateDate: | 03/11/2019 | ||||||||
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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 | SZ8290 | FL | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SA16524 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.