Provider Demographics
NPI:1841733060
Name:SKIBA, HAILEY AMBER (MA)
Entity type:Individual
Prefix:MS
First Name:HAILEY
Middle Name:AMBER
Last Name:SKIBA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8840 CYPRESS WATERS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4630
Mailing Address - Country:US
Mailing Address - Phone:507-330-3212
Mailing Address - Fax:
Practice Address - Street 1:273 E BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3775
Practice Address - Country:US
Practice Address - Phone:323-724-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-19
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60869951235Z00000X
390200000X
CA30894235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program