Provider Demographics
NPI:1922490598
Name:ADDIS, HALEY (M/S/, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:ADDIS
Suffix:
Gender:F
Credentials:M/S/, CCC-SLP
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:
Other - Last Name:SLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 CENTER ROCK GRN STE 10
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-3170
Mailing Address - Country:US
Mailing Address - Phone:203-828-6790
Mailing Address - Fax:203-800-3548
Practice Address - Street 1:350 CENTER ROCK GRN STE 10
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-3170
Practice Address - Country:US
Practice Address - Phone:203-828-6790
Practice Address - Fax:203-800-3548
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004943235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist