Provider Demographics
NPI:1619404365
Name:SMITH, HALLEY
Entity Type:Individual
Prefix:
First Name:HALLEY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6573 CLARK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3522
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6573 CLARK RD
Practice Address - Street 2:SUITE B
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3522
Practice Address - Country:US
Practice Address - Phone:530-413-9376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA8213237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist