Healthcare Provider Details

I. General information

NPI: 1922966670
Provider Name (Legal Business Name): HAILEY MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 MCDONALD AVE
KINGMAN AZ
86401-4235
US

IV. Provider business mailing address

3700 PROSPECTOR ST
KINGMAN AZ
86401-1901
US

V. Phone/Fax

Practice location:
  • Phone: 928-753-5678
  • Fax:
Mailing address:
  • Phone: 928-753-2472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA16938
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: