Healthcare Provider Details

I. General information

NPI: 1548780513
Provider Name (Legal Business Name): LORNA A MARTIN MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 WILHELMINA RISE STE B
HONOLULU HI
96816
US

IV. Provider business mailing address

1210 WILHELMINA RISE STE B
HONOLULU HI
96816-3287
US

V. Phone/Fax

Practice location:
  • Phone: 808-260-9056
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number76695
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1655
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1768
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: