Healthcare Provider Details

I. General information

NPI: 1932017373
Provider Name (Legal Business Name): HALEY ANN WILLMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2500 RODGERS ST
CHESAPEAKE VA
23324-1960
US

IV. Provider business mailing address

1421 KRISTINA WAY
CHESAPEAKE VA
23320-8917
US

V. Phone/Fax

Practice location:
  • Phone: 757-494-7590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202012622
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: