Provider Demographics
NPI:1568813525
Name:NORDSKOG, HALEY SUE
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:SUE
Last Name:NORDSKOG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:SUE
Other - Last Name:EASTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3060 FRONTIER WAY S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3175 SIENNA DR S, STE 103
Practice Address - Street 2:STE 103
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5810
Practice Address - Country:US
Practice Address - Phone:701-532-1906
Practice Address - Fax:701-532-1896
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1513235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist