Provider Demographics
NPI:1811629538
Name:BACKES, HAILEY ANNE (SLP)
Entity Type:Individual
Prefix:MS
First Name:HAILEY
Middle Name:ANNE
Last Name:BACKES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 W CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61362-1821
Mailing Address - Country:US
Mailing Address - Phone:815-780-7572
Mailing Address - Fax:
Practice Address - Street 1:1100 E NORRIS DR
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-1604
Practice Address - Country:US
Practice Address - Phone:815-431-5316
Practice Address - Fax:815-431-5305
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.006770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist