Healthcare Provider Details

I. General information

NPI: 1760095830
Provider Name (Legal Business Name): HALEY ALEXIS THOMAS MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N CHURCH ST
MONROE NC
28112-4804
US

IV. Provider business mailing address

5505 JERUSALEM CHURCH RD
MARSHVILLE NC
28103-9593
US

V. Phone/Fax

Practice location:
  • Phone: 704-296-9898
  • Fax:
Mailing address:
  • Phone: 803-528-4515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14393
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: