Basic Information
| Provider Information | |||||||||
| NPI: | 1922624030 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALEY | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | THERESA | ||||||||
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| Credential: | MA, CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 133 E CONCORD ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328011334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7724862055 | ||||||||
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| Practice Location | |||||||||
| Address1: | 756 N SUN DR | ||||||||
| Address2: | |||||||||
| City: | LAKE MARY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327462507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078523347 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2020 | ||||||||
| LastUpdateDate: | 06/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251V00000X | N | Agencies | Voluntary or Charitable | 235Z00000X | 9566 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.