Provider Demographics
NPI:1851953459
Name:HUGHSTON, HAYLEY (MED, CCC- SLP)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:HUGHSTON
Suffix:
Gender:F
Credentials:MED, CCC- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2332
Mailing Address - Country:US
Mailing Address - Phone:912-331-0846
Mailing Address - Fax:
Practice Address - Street 1:607 JACKSON ST UNIT 2
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4721
Practice Address - Country:US
Practice Address - Phone:912-331-0846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET002902235Z00000X
GASLP011051235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA261363433Medicaid