Provider Demographics
NPI:1912777848
Name:GONSALVES, HAILEY ROSE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:ROSE
Last Name:GONSALVES
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MEADOW ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3612
Mailing Address - Country:US
Mailing Address - Phone:203-915-3225
Mailing Address - Fax:
Practice Address - Street 1:400 BRITTANY FARMS RD
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-1154
Practice Address - Country:US
Practice Address - Phone:860-224-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist