Basic Information
Provider Information | |||||||||
NPI: | 1902190598 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LONIDIER | ||||||||
FirstName: | HALEY | ||||||||
MiddleName: | H | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MS, CFY-SLP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HEIRTZLER | ||||||||
OtherFirstName: | HALEY | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 83 AIRWAYS PL | ||||||||
Address2: |   | ||||||||
City: | SOUTHAVEN | ||||||||
State: | MS | ||||||||
PostalCode: | 386715885 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6623498787 | ||||||||
FaxNumber: | 6623498757 | ||||||||
Practice Location | |||||||||
Address1: | 83 AIRWAYS PL | ||||||||
Address2: |   | ||||||||
City: | SOUTHAVEN | ||||||||
State: | MS | ||||||||
PostalCode: | 386715885 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6623498787 | ||||||||
FaxNumber: | 6623498757 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/01/2011 | ||||||||
LastUpdateDate: | 06/01/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | S3563 | MS | Y |   | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |   |
ID Information
ID | Type | State | Issuer | Description | S3563 | 01 | MS | SPEECH LICENSE | OTHER |