| Doctor Name: | CLARISSA MARTIN |
| NPI Number: | 1306246475 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 7101001168 |
| Business Practice Address: | 2206 Mitchell Park Dr Unit 14 Petoskey, MI - 497708674 |
| Business Phone Number: | 2313487777 |
| Business Fax Number: | |
| Mailing Address: | 94 W Cooper Rd, SANDUSKY |
| State: | MI |
| Postal Code: | 484719419 |
| Phone Number: | 8108371237 |
| Fax Number: | |
| NPI Enumeration Date: | 08/26/2014 |
| NPI Last Update Date: | 08/26/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 7101001168 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |