Provider Demographics
NPI:1821543687
Name:VRADENBURGH, HALEY GOWER (CCC- SLP)
Entity Type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:GOWER
Last Name:VRADENBURGH
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 1:111 S RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-4853
Mailing Address - Country:US
Mailing Address - Phone:910-892-0027
Mailing Address - Fax:
Practice Address - Street 1:907 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-5839
Practice Address - Country:US
Practice Address - Phone:910-814-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11260235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist