| Doctor Name: | HALEY ADDIS |
| NPI Number: | 1922490598 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SLP |
| License Number: | 004943 |
| Business Practice Address: | 1931 Black Rock Tpke Fairfield, CT - 068253506 |
| Business Phone Number: | 2033848681 |
| Business Fax Number: | 2033840722 |
| Mailing Address: | 1931 Black Rock Tpke, Attn: Credentialing FAIRFIELD |
| State: | CT |
| Postal Code: | 068253506 |
| Phone Number: | 2033324363 |
| Fax Number: | 2033306761 |
| NPI Enumeration Date: | 02/19/2015 |
| NPI Last Update Date: | 09/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 004943 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| 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 |