Individual
HAILEY C SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CF-SLP
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
(765) 448-8085
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
46002013A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000637626
ANTHEM PROVIDER NUMBER
IN
05
—
200963810
—
IN
Enumeration date
09/18/2009
Last updated
05/13/2010
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