Provider Demographics
NPI:1174202139
Name:HALEY, CRYSTAL DAISY (HIS)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DAISY
Last Name:HALEY
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10912 E MAXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-2500
Mailing Address - Country:US
Mailing Address - Phone:509-710-2395
Mailing Address - Fax:
Practice Address - Street 1:6 W JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6239
Practice Address - Country:US
Practice Address - Phone:509-483-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61331143237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist