Provider Demographics
NPI:1437729001
Name:DENHARTOG, HALEY KRISTENE
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:KRISTENE
Last Name:DENHARTOG
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:HALEY
Other - Middle Name:KRISTENE
Other - Last Name:TSOLAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2633 XENWOOD AVE S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1726
Mailing Address - Country:US
Mailing Address - Phone:952-923-6162
Mailing Address - Fax:
Practice Address - Street 1:3800 PARK NICOLLET BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2527
Practice Address - Country:US
Practice Address - Phone:952-993-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MN518197235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist