Provider Demographics
NPI:1174669444
Name:HALEGOUA, PERLA (MA,CCC)
Entity Type:Individual
Prefix:MS
First Name:PERLA
Middle Name:
Last Name:HALEGOUA
Suffix:
Gender:F
Credentials:MA,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CRESCENT RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1208
Mailing Address - Country:US
Mailing Address - Phone:631-928-6199
Mailing Address - Fax:
Practice Address - Street 1:1 CRESCENT RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1208
Practice Address - Country:US
Practice Address - Phone:631-928-6199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001691-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist