Healthcare Provider Details

I. General information

NPI: 1841820701
Provider Name (Legal Business Name): LENAE HALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10310 W MARKHAM ST STE 210
LITTLE ROCK AR
72205-1579
US

IV. Provider business mailing address

3321 S BOWMAN RD APT 1011
LITTLE ROCK AR
72211-4684
US

V. Phone/Fax

Practice location:
  • Phone: 501-406-7910
  • Fax:
Mailing address:
  • Phone: 870-783-0208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number200945
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: