Provider Demographics
NPI:1336759281
Name:CUNDIFF, HAILEY N (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:N
Last Name:CUNDIFF
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N SEYMOUR ST
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:61858-6404
Mailing Address - Country:US
Mailing Address - Phone:217-474-8301
Mailing Address - Fax:
Practice Address - Street 1:801 N LOGAN AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3715
Practice Address - Country:US
Practice Address - Phone:217-474-8301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.015327235Z00000X
INCV2003140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist