Provider Demographics
NPI:1831428762
Name:HAYNES, VALERIE NICOLE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:NICOLE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 SLATE RUN RD.
Mailing Address - Street 2:# 32
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150
Mailing Address - Country:US
Mailing Address - Phone:812-698-1630
Mailing Address - Fax:
Practice Address - Street 1:7823 OLD STATE ROAD 60
Practice Address - Street 2:SELLERSBURG HEALTH AND REHAB CENTER
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172
Practice Address - Country:US
Practice Address - Phone:812-246-4272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004894A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist