Provider Demographics
NPI:1174093033
Name:GOMEZ, HAYLEY MICHELLE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:HAYLEY
Middle Name:MICHELLE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:HAYLEY
Other - Middle Name:MICHELLE
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6716 SAVANNAH LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3728
Mailing Address - Country:US
Mailing Address - Phone:817-266-8488
Mailing Address - Fax:
Practice Address - Street 1:7201 HAWKINS VIEW DR STE 151
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3934
Practice Address - Country:US
Practice Address - Phone:817-479-7019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08771235Z00000X
TX116816235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist