Healthcare Provider Details

I. General information

NPI: 1659111474
Provider Name (Legal Business Name): HALEY GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 9TH ST
RICHMOND VA
23219-1933
US

IV. Provider business mailing address

232 LORENZ BLVD APT D
JACKSON MS
39216-3802
US

V. Phone/Fax

Practice location:
  • Phone: 804-780-7710
  • Fax:
Mailing address:
  • Phone: 601-551-6029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2204001366
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: