Healthcare Provider Details

I. General information

NPI: 1659285443
Provider Name (Legal Business Name): RAEANNA M MARTIN-HAYDEN
Entity Type: Individual
Gender: Female
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

1201 100TH ST NE
GRANITE FALLS WA
98252-8632
US

IV. Provider business mailing address

9815 HOLLY DR APT A112
EVERETT WA
98204-1121
US

V. Phone/Fax

Practice location:
  • Phone: 360-283-4409
  • Fax:
Mailing address:
  • Phone: 419-206-0368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLPI.SI.70159821
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: