Provider Demographics
NPI:1467765057
Name:HALES, MAGGIE ROSS (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:MAGGIE
Middle Name:ROSS
Last Name:HALES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TRAVIS LN
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:NY
Mailing Address - Zip Code:10548-1014
Mailing Address - Country:US
Mailing Address - Phone:914-469-3526
Mailing Address - Fax:914-737-0563
Practice Address - Street 1:4 TRAVIS LN
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548-1014
Practice Address - Country:US
Practice Address - Phone:914-469-3526
Practice Address - Fax:914-737-0563
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019897235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist