Healthcare Provider Details

I. General information

NPI: 1538024351
Provider Name (Legal Business Name): HAILEY SUSAN WREATH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WEST AVE
WAYNE PA
19087-3322
US

IV. Provider business mailing address

30 WEST AVE
WAYNE PA
19087-3322
US

V. Phone/Fax

Practice location:
  • Phone: 610-688-3635
  • Fax:
Mailing address:
  • Phone: 610-688-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPSL003126
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: