Provider Demographics
NPI:1215816400
Name:PETERSON, HAILEY
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-0217
Mailing Address - Country:US
Mailing Address - Phone:479-453-9664
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 217
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72811-0217
Practice Address - Country:US
Practice Address - Phone:479-453-9664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty