Haley Marie Gustavson

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

006209 Issued in CT

Practice address

30 Avon Meadow LN
Avon, CT 06001-3745

Phone

(860) 284-9779

Fax

(860) 409-4120

NPI assigned

Jul 17, 2020

Last updated

Jul 17, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Creative Development, LLC

  • Specialist
  • Avon, CT
  • NPI 1295928075

  Speech-Language Pathologist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594944000000",
    "number": "1609484427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 AVON MEADOW LN",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013745",
            "telephone_number": "860-284-9779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 AVON MEADOW LN",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013745",
            "telephone_number": "860-284-9779",
            "fax_number": "860-409-4120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAVSON",
        "first_name": "HALEY",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-17",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CT",
            "license": "006209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Veronique Green, LMSW
• Allison Greenberg, DDS
• Ira M Greene, D.D.S.
• Lisa Marie Gronski, D.O.
• Amanda Rose Guido, APRN
• Timothy Habegger, LCSW
• Wendy F Habelow, PHD CLINICAL PSYCHOL
• Marsha Hahn, LCSW
• Courtney Hall, LCSW
• Hands on Therapy Center LLC

• Speech-Language Pathologist in Avon, CT
• Providers in Avon, CT by specialty
• Speech-Language Pathologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.