Provider Demographics
NPI:1588363477
Name:ANDERSON, HAILY
Entity type:Individual
Prefix:
First Name:HAILY
Middle Name:
Last Name:ANDERSON
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 1:104 BARRACUDA AVE SE
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:MN
Mailing Address - Zip Code:56310-8678
Mailing Address - Country:US
Mailing Address - Phone:320-241-7690
Mailing Address - Fax:
Practice Address - Street 1:230 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MN
Practice Address - Zip Code:56307-9489
Practice Address - Country:US
Practice Address - Phone:320-845-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN518112235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist