Provider Demographics
NPI:1366066722
Name:HALLEY, REBECCA MARY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARY
Last Name:HALLEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MARY
Other - Last Name:KLAZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3831 HALEYS WAY
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1155
Mailing Address - Country:US
Mailing Address - Phone:573-275-7720
Mailing Address - Fax:
Practice Address - Street 1:285 SE INNER LOOP STE 108
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-2139
Practice Address - Country:US
Practice Address - Phone:512-763-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107470235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist