Healthcare Provider Details

I. General information

NPI: 1891329587
Provider Name (Legal Business Name): HALEY YEAGER CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 OLD ORCHARD DR
PLANO TX
75023-4129
US

IV. Provider business mailing address

6525 OLD ORCHARD DR
PLANO TX
75023-4129
US

V. Phone/Fax

Practice location:
  • Phone: 469-752-0690
  • Fax:
Mailing address:
  • Phone: 469-752-0690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number126520
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: