=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659285443
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAEANNA M MARTIN-HAYDEN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2026
-----------------------------------------------------
Last Update Date | 09/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 100TH ST NE
-----------------------------------------------------
City | GRANITE FALLS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98252-8632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-283-4409
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9815 HOLLY DR APT A112
-----------------------------------------------------
City | EVERETT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98204-1121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-206-0368
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SLPI.SI.70159821
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------