Healthcare Provider Details

I. General information

NPI: 1487572582
Provider Name (Legal Business Name): HAILEY MARAE HALDEMAN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 RACHEL ST
TROY ID
83871-9699
US

IV. Provider business mailing address

801 RACHEL ST
TROY ID
83871-9699
US

V. Phone/Fax

Practice location:
  • Phone: 509-330-1910
  • Fax:
Mailing address:
  • Phone: 509-330-1910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number015545
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: