Provider Demographics
NPI:1013685742
Name:CALDWELL, HALEIGH (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HALEIGH
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 BRINELL ST E APT 118
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3789
Mailing Address - Country:US
Mailing Address - Phone:740-645-8477
Mailing Address - Fax:
Practice Address - Street 1:4400 MARKETING PL STE B
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-9308
Practice Address - Country:US
Practice Address - Phone:614-492-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.14564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP.14564Medicaid