Provider Demographics
NPI:1518526326
Name:DIDELOTTE, HALEY TRICIA LYNN (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:HALEY
Middle Name:TRICIA LYNN
Last Name:DIDELOTTE
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 1:7948 N HAYDEN RD # EE203
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3214
Mailing Address - Country:US
Mailing Address - Phone:623-414-0139
Mailing Address - Fax:
Practice Address - Street 1:4309 E FLORIAN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2798
Practice Address - Country:US
Practice Address - Phone:602-773-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP11803235Z00000X
AZTSLP11803225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist