Provider Demographics
NPI:1023497450
Name:HALEY, SUSAN (MS, CCC-SLP, ATP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:HALEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP, ATP
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:HARTNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP, ATP
Mailing Address - Street 1:395 BROADWAY APT R4C
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1635
Mailing Address - Country:US
Mailing Address - Phone:617-828-5355
Mailing Address - Fax:
Practice Address - Street 1:395 BROADWAY APT R4C
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1635
Practice Address - Country:US
Practice Address - Phone:617-828-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist