Provider Demographics
NPI:1952857575
Name:VAN BUSKIRK, HAYLEY (MS)
Entity Type:Individual
Prefix:MISS
First Name:HAYLEY
Middle Name:
Last Name:VAN BUSKIRK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MEDICAL DRIVE
Mailing Address - Street 2:LIFESPAN THERAPY
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:170 LOVE AVE
Practice Address - Street 2:APT K
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-2155
Practice Address - Country:US
Practice Address - Phone:812-230-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46002942A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist