Provider Demographics
NPI:1366925794
Name:GREEN, HALEY
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 ACADEMY CIR STE 100B
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1664
Mailing Address - Country:US
Mailing Address - Phone:719-598-5555
Mailing Address - Fax:719-388-2030
Practice Address - Street 1:2105 ACADEMY CIR STE 100B
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1664
Practice Address - Country:US
Practice Address - Phone:719-598-5555
Practice Address - Fax:719-388-2030
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0004131235Z00000X
LA6589235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist