Provider Demographics
NPI:1154655033
Name:HALEY, KRISTA D (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:D
Last Name:HALEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 PLEASANT ST STE 16
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-6534
Mailing Address - Country:US
Mailing Address - Phone:781-641-3533
Mailing Address - Fax:781-641-3533
Practice Address - Street 1:55 MOUNT PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:MA
Practice Address - Zip Code:01966-1712
Practice Address - Country:US
Practice Address - Phone:978-546-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4761235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist