MEDICARE: HALEY HUEY PURVIS SLP

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	S3982	MS

General Provider Information

NPI Number	:	1457739849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY HUEY PURVIS SLP

Provider Business Mailing Address
First Line	:	381 RIVERSIDE DR STE 440
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064-8934
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1129 HIGHWAY 35 S STE 2
Second Line	:
City	:	FOREST
State	:	MS
Zip	:	39074-8829
Country	:	US
Telephone Number	:	601-469-1001
Fax Number	:	601-469-1009

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

Provider Enumeration Date	:	05/18/2015
Last Update Date	:	10/03/2018

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Directions to “ HALEY HUEY PURVIS SLP” Practice Location

Language	Start Address	Practice Location

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