Provider Demographics
NPI:1275377160
Name:WILLMENT, HALEY NICOLE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:NICOLE
Last Name:WILLMENT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 BLUEBELL WAY
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7648
Mailing Address - Country:US
Mailing Address - Phone:805-722-2054
Mailing Address - Fax:
Practice Address - Street 1:187 TANK FARM RD STE 210
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7085
Practice Address - Country:US
Practice Address - Phone:805-547-1755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31958235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist