Doctor Name: | HAYLEY WALLACE |
NPI Number: | 1194011593 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC-SLP |
License Number: | 104347 |
Business Practice Address: | 6862 Whitby Ln #4 Groves, TX - 776194965 |
Business Phone Number: | 4095430977 |
Business Fax Number: | |
Mailing Address: | 6862 Whitby Ln, #4 GROVES |
State: | TX |
Postal Code: | 776194965 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/23/2011 |
NPI Last Update Date: | 06/23/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 104347 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |