Provider Demographics
NPI:1851831978
Name:ROBERTS, HAYLEY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 BRIDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-7287
Mailing Address - Country:US
Mailing Address - Phone:570-396-9113
Mailing Address - Fax:
Practice Address - Street 1:2802 BRIDLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-7287
Practice Address - Country:US
Practice Address - Phone:570-396-9113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.13255235Z00000X
IL242.003899235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty