Healthcare Provider Details

I. General information

NPI: 1790410199
Provider Name (Legal Business Name): YSAHAI HONOR-MARIE MARTIN MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GRAND RIVER AVE
DETROIT MI
48204-2132
US

IV. Provider business mailing address

3434 CHENE ST UNIT 7184
DETROIT MI
48207-7708
US

V. Phone/Fax

Practice location:
  • Phone: 313-491-7920
  • Fax:
Mailing address:
  • Phone: 313-320-4133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12111669
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: