Provider Demographics
NPI:1376352534
Name:LILES, HALLE KATHERINE (MCD, CF-SLP)
Entity type:Individual
Prefix:
First Name:HALLE
Middle Name:KATHERINE
Last Name:LILES
Suffix:
Gender:F
Credentials:MCD, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 QUAIL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-7780
Mailing Address - Country:US
Mailing Address - Phone:870-243-0829
Mailing Address - Fax:
Practice Address - Street 1:5603 KERSEY LN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-8804
Practice Address - Country:US
Practice Address - Phone:870-935-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist