Provider Demographics
NPI:1013066356
Name:HALLER, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HALLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18001 OLD CUTLER RD
Mailing Address - Street 2:SUITE 354
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6422
Mailing Address - Country:US
Mailing Address - Phone:305-251-7477
Mailing Address - Fax:305-251-7475
Practice Address - Street 1:18001 OLD CUTLER RD
Practice Address - Street 2:SUITE 354
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6422
Practice Address - Country:US
Practice Address - Phone:305-251-7477
Practice Address - Fax:305-251-7475
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX360182355S0801X
FLSI8632355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1013066356Medicaid