Provider Demographics
NPI:1417792029
Name:HALLEY, CARLY (AUD)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:HALLEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:WALKUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:314-685-0097
Mailing Address - Fax:
Practice Address - Street 1:2817 ROCK MERRITT AVE
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-8922
Practice Address - Fax:910-907-6069
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13998525-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist