Provider Demographics
NPI:1255103396
Name:HADLEY, AUDRA BETH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:BETH
Last Name:HADLEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:BETH
Other - Last Name:ALLCORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6125 LYNNHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-5329
Mailing Address - Country:US
Mailing Address - Phone:806-240-5645
Mailing Address - Fax:
Practice Address - Street 1:6125 LYNNHAVEN DR
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-5329
Practice Address - Country:US
Practice Address - Phone:806-240-5645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121575246Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Pathology