Provider Demographics
NPI:1760997589
Name:HAYNES, CALLIE TAYLOR (MS, CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:TAYLOR
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 VILLAGE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-5308
Mailing Address - Country:US
Mailing Address - Phone:270-501-0496
Mailing Address - Fax:
Practice Address - Street 1:944 FIELDS DR STE 102
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104
Practice Address - Country:US
Practice Address - Phone:270-495-1312
Practice Address - Fax:270-495-1351
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY242526235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist