Basic Information
| Provider Information | |||||||||
| NPI: | 1891262705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALLADAY | ||||||||
| FirstName: | KIRSTEN | ||||||||
| MiddleName: | ALEXANDRIA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S. CF-SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HARTZ | ||||||||
| OtherFirstName: | KIRSTEN | ||||||||
| OtherMiddleName: | ALEXANDRIA | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6759 N 77TH DR | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853032939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794660110 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9940 W UNION HILLS DR | ||||||||
| Address2: | |||||||||
| City: | SUN CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853731673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239330022 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2018 | ||||||||
| LastUpdateDate: | 10/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | TSLP11410 | AZ | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.