MEDICARE: MRS. HEATHER STUBBS HAYNES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA8659	FL

General Provider Information

NPI Number	:	1073748570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER STUBBS HAYNES

Provider Business Mailing Address
First Line	:	11994 OLDFIELD POINTE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-3534
Country	:	US
Telephone Number	:	904-226-1185
Fax Number	:

Provider Business Practice Location Address
First Line	:	11994 OLDFIELD POINTE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-3534
Country	:	US
Telephone Number	:	904-226-1185
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2009
Last Update Date	:	05/27/2009

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Directions to “ MRS. HEATHER STUBBS HAYNES ” Practice Location

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