Provider Demographics
NPI:1861726960
Name:HALEY, SUZANNE (SLP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:HALEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:H
Other - Last Name:PORTERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:423 ASHLEY TER
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8349
Mailing Address - Country:US
Mailing Address - Phone:601-503-5656
Mailing Address - Fax:
Practice Address - Street 1:423 ASHLEY TER
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8349
Practice Address - Country:US
Practice Address - Phone:601-503-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS0121235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist