Provider Demographics
NPI:1790410199
Name:MARTIN, YSAHAI HONOR-MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:YSAHAI
Middle Name:HONOR-MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 CHENE ST UNIT 7184
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-7708
Mailing Address - Country:US
Mailing Address - Phone:313-320-4133
Mailing Address - Fax:
Practice Address - Street 1:9500 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-2132
Practice Address - Country:US
Practice Address - Phone:313-491-7920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12111669235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist