Healthcare Provider Details

I. General information

NPI: 1851134530
Provider Name (Legal Business Name): CAMERON MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8175 MOVIE DR
BRIGHTON MI
48116-7444
US

IV. Provider business mailing address

263 LEROY AVE
CLAWSON MI
48017-1207
US

V. Phone/Fax

Practice location:
  • Phone: 248-277-3005
  • Fax:
Mailing address:
  • Phone: 248-410-5465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: