Basic Information
| Provider Information | |||||||||
| NPI: | 1407597040 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZOELLER | ||||||||
| FirstName: | HALEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS CCC SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 411 E CHESTNUT ST STE 545 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026297998 | ||||||||
| FaxNumber: | 5026297178 | ||||||||
| Practice Location | |||||||||
| Address1: | 411 E CHESTNUT ST # 5 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025880390 | ||||||||
| FaxNumber: | 5025880396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2022 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 173756 | KY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.