MEDICARE: HALLEY WALSH CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist		MN

General Provider Information

NPI Number	:	1205767639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALLEY WALSH CCC-SLP

Provider Business Mailing Address
First Line	:	11408 ZION RD
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55437-3634
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11408 ZION RD
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55437-3634
Country	:	US
Telephone Number	:	612-440-7845
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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Directions to “ HALLEY WALSH CCC-SLP” Practice Location

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