Provider Demographics
NPI:1710449293
Name:HARALSON, HAYLEY NICOLE (CPM)
Entity type:Individual
Prefix:MRS
First Name:HAYLEY
Middle Name:NICOLE
Last Name:HARALSON
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13348 W OCUPADO DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-6079
Mailing Address - Country:US
Mailing Address - Phone:405-658-6248
Mailing Address - Fax:
Practice Address - Street 1:4870 N LITCHFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-5041
Practice Address - Country:US
Practice Address - Phone:405-658-6248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5114235Z00000X
AZLM280176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist