Provider Demographics
NPI:1073748570
Name:HAYNES, HEATHER STUBBS
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:STUBBS
Last Name:HAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11994 OLDFIELD POINTE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-3534
Mailing Address - Country:US
Mailing Address - Phone:904-226-1185
Mailing Address - Fax:
Practice Address - Street 1:11994 OLDFIELD POINTE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-3534
Practice Address - Country:US
Practice Address - Phone:904-226-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8659235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist