Provider Demographics
NPI:1275356875
Name:FRITZ, HALIE LOREN (HAS)
Entity type:Individual
Prefix:
First Name:HALIE
Middle Name:LOREN
Last Name:FRITZ
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PALM BAY RD STE C
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3851
Mailing Address - Country:US
Mailing Address - Phone:321-576-1233
Mailing Address - Fax:321-576-1235
Practice Address - Street 1:1400 PALM BAY RD STE C
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3851
Practice Address - Country:US
Practice Address - Phone:321-576-1233
Practice Address - Fax:321-576-1235
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5855237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist