Healthcare Provider Details

I. General information

NPI: 1043126550
Provider Name (Legal Business Name): MRS. MARINA HAMLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N LAFAYETTE ST
SOUTH LYON MI
48178-2002
US

IV. Provider business mailing address

11255 CLYDE RD
FENTON MI
48430-9537
US

V. Phone/Fax

Practice location:
  • Phone: 248-573-8150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101001038
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: