Provider Demographics
NPI:1225322696
Name:HAVERSON, NANCY (SLP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:HAVERSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12708 CORAL LAKES DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-4142
Mailing Address - Country:US
Mailing Address - Phone:203-912-4186
Mailing Address - Fax:
Practice Address - Street 1:12708 CORAL LAKES DR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-4142
Practice Address - Country:US
Practice Address - Phone:203-912-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA-13324235Z00000X
CT1145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist