Healthcare Provider Details

I. General information

NPI: 1861306532
Provider Name (Legal Business Name): HANNAH MARTIN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6238 W MAIN ST
EAU CLAIRE MI
49111-9328
US

IV. Provider business mailing address

6585 SNYDER RD
BERRIEN SPRINGS MI
49103-9610
US

V. Phone/Fax

Practice location:
  • Phone: 269-461-6191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101008629
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: