Provider Demographics
NPI:1922624030
Name:HALEY, STEPHANIE THERESA (MA, CF-SLP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:THERESA
Last Name:HALEY
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1334
Mailing Address - Country:US
Mailing Address - Phone:772-486-2055
Mailing Address - Fax:
Practice Address - Street 1:756 N SUN DR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2507
Practice Address - Country:US
Practice Address - Phone:407-852-3347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251V00000X
FL9566235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No251V00000XAgenciesVoluntary or Charitable