Provider Demographics
NPI:1902179443
Name:HALLERAN, RHONDA (SLP)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:HALLERAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:COLUMBIAVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12050-0014
Mailing Address - Country:US
Mailing Address - Phone:518-828-4073
Mailing Address - Fax:
Practice Address - Street 1:424 MAIN STREET
Practice Address - Street 2:CAIRO ELEMENTARY SCHOOL
Practice Address - City:CAIRO
Practice Address - State:NY
Practice Address - Zip Code:12413
Practice Address - Country:US
Practice Address - Phone:518-828-4073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014516-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist