Provider Demographics
NPI:1891262705
Name:HALLADAY, KIRSTEN ALEXANDRIA (MS CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:ALEXANDRIA
Last Name:HALLADAY
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:ALEXANDRIA
Other - Last Name:HARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6759 N 77TH DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-2939
Mailing Address - Country:US
Mailing Address - Phone:479-466-0110
Mailing Address - Fax:
Practice Address - Street 1:9940 W UNION HILLS DR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-1673
Practice Address - Country:US
Practice Address - Phone:623-933-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP11410235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist