Provider Demographics
NPI:1891037180
Name:HALES, AUDRA MARIE (MS, CCC- SLP)
Entity Type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:MARIE
Last Name:HALES
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 1:10 MARISOL ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1393
Mailing Address - Country:US
Mailing Address - Phone:619-204-1989
Mailing Address - Fax:
Practice Address - Street 1:10 MARISOL ST
Practice Address - Street 2:
Practice Address - City:RANCHO MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92694-1393
Practice Address - Country:US
Practice Address - Phone:619-204-1989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21661235Z00000X
CA8202235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist