Provider Demographics
NPI:1194604595
Name:BOSTIC, HALEY NICOLE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:NICOLE
Last Name:BOSTIC
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:HALEY
Other - Middle Name:NICOLE
Other - Last Name:WILBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:68 W WILSON ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-4454
Mailing Address - Country:US
Mailing Address - Phone:304-437-5728
Mailing Address - Fax:
Practice Address - Street 1:71 UTT DR
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-7449
Practice Address - Country:US
Practice Address - Phone:304-265-2497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-2460235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist