Provider Demographics
NPI:1376153973
Name:KNOWLTON, HALEIGH ELIZABETH (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HALEIGH
Middle Name:ELIZABETH
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:7 COLLEEN MARY WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1281
Mailing Address - Country:US
Mailing Address - Phone:774-273-1405
Mailing Address - Fax:
Practice Address - Street 1:101 AMESBURY ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1323
Practice Address - Country:US
Practice Address - Phone:978-975-0395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77718235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA77718OtherMASSACHUSETTS BOARD OF REGISTRATION FOR SPEECH LANGUAGE PATHOLOGY AND AUDIOLOGY