Provider Demographics
NPI:1407464621
Name:HENDERSON, HALEY (SLP)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:
Other - Last Name:SCHAFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 S OCEAN LN APT 1908
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-3827
Mailing Address - Country:US
Mailing Address - Phone:567-204-3098
Mailing Address - Fax:
Practice Address - Street 1:9711 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7013
Practice Address - Country:US
Practice Address - Phone:954-572-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9670235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherN/A