Provider Demographics
NPI:1689394579
Name:MARTIN, IAN (HAS)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 GLEN ESTE WITHAMSVILLE RD STE 475
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1340
Mailing Address - Country:US
Mailing Address - Phone:513-947-8470
Mailing Address - Fax:513-947-8428
Practice Address - Street 1:4440 GLEN ESTE WITHAMSVILLE RD STE 475
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1340
Practice Address - Country:US
Practice Address - Phone:513-947-8470
Practice Address - Fax:513-947-8428
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHIL.03467237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist