Provider Demographics
NPI:1144426172
Name:ROBERTSON, HAYLEY (SLP)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:HAYLEY
Other - Middle Name:
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:PO BOX 1790
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-1790
Mailing Address - Country:US
Mailing Address - Phone:307-358-9464
Mailing Address - Fax:307-358-9330
Practice Address - Street 1:953 WALNUT ST UNIT A
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-2666
Practice Address - Country:US
Practice Address - Phone:307-322-1878
Practice Address - Fax:307-322-1879
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-399235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist