Provider Demographics
NPI:1922830967
Name:HALEY, TAYLOR RENEE (MS CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:RENEE
Last Name:HALEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:I012 COUNTY ROAD 2
Mailing Address - Street 2:
Mailing Address - City:CUSTAR
Mailing Address - State:OH
Mailing Address - Zip Code:43511-9604
Mailing Address - Country:US
Mailing Address - Phone:586-610-4616
Mailing Address - Fax:
Practice Address - Street 1:18505 TONTOGANY CREEK RD STE 1
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-9037
Practice Address - Country:US
Practice Address - Phone:419-823-4381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.16115235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist