Provider Demographics
NPI:1912564147
Name:EUSTICE, HAILEY AMANDA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:AMANDA
Last Name:EUSTICE
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 1:3615 SPICER DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-7043
Mailing Address - Country:US
Mailing Address - Phone:541-967-7551
Mailing Address - Fax:541-967-5095
Practice Address - Street 1:3615 SPICER DR SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-7043
Practice Address - Country:US
Practice Address - Phone:541-967-7551
Practice Address - Fax:541-967-5095
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist