Provider Demographics
NPI:1558740134
Name:SMITH, HALEY BULLS (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:BULLS
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:E
Other - Last Name:BULLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3166 CLARKSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-8015
Mailing Address - Country:US
Mailing Address - Phone:903-784-7702
Mailing Address - Fax:903-784-7703
Practice Address - Street 1:3166 CLARKSVILLE ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-8015
Practice Address - Country:US
Practice Address - Phone:903-784-7702
Practice Address - Fax:903-784-7703
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107404235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
107404OtherTEXAS SPEECH PATHOLOGIST LICENSE
14063433OtherAMERICAN SPEECH AND HEARING ASSOCIATION