Provider Demographics
NPI:1740806371
Name:DAHLKE, HALEY ROSE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:ROSE
Last Name:DAHLKE
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 1:2373 SEASIDE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-1406
Mailing Address - Country:US
Mailing Address - Phone:920-251-7150
Mailing Address - Fax:
Practice Address - Street 1:5703 OBERLIN DR STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1743
Practice Address - Country:US
Practice Address - Phone:619-535-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist