Provider Demographics
NPI:1376375105
Name:MARTIN, CAILYNN LOUISE
Entity type:Individual
Prefix:
First Name:CAILYNN
Middle Name:LOUISE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:IL
Mailing Address - Zip Code:62640-1209
Mailing Address - Country:US
Mailing Address - Phone:217-883-1657
Mailing Address - Fax:
Practice Address - Street 1:456 BERTRAND DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62563-9283
Practice Address - Country:US
Practice Address - Phone:217-782-1979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.007792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist