Healthcare Provider Details

I. General information

NPI: 1154073864
Provider Name (Legal Business Name): CASSIE MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 TIGER BLVD
BENTONVILLE AR
72712-4208
US

IV. Provider business mailing address

500 TIGER BLVD
BENTONVILLE AR
72712-4208
US

V. Phone/Fax

Practice location:
  • Phone: 479-254-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number202945
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: