Provider Demographics
NPI:1649819905
Name:BROWN, HALEY JO (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:JO
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:MISS
Other - First Name:HALEY
Other - Middle Name:JO
Other - Last Name:LUTTEKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:1210 W 18TH ST STE LL01
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-4655
Mailing Address - Country:US
Mailing Address - Phone:605-328-1860
Mailing Address - Fax:
Practice Address - Street 1:1417 S CLIFF AVE STE 300
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1062
Practice Address - Country:US
Practice Address - Phone:605-504-3042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD719235Z00000X
SD719-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist