Provider Demographics
NPI:1063244903
Name:HAYES, CAROLINE SUESANN (EDS)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:SUESANN
Last Name:HAYES
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 ULLIN AVE
Mailing Address - Street 2:
Mailing Address - City:ULLIN
Mailing Address - State:IL
Mailing Address - Zip Code:62992-1014
Mailing Address - Country:US
Mailing Address - Phone:618-634-9800
Mailing Address - Fax:618-634-9864
Practice Address - Street 1:751 ULLIN AVE
Practice Address - Street 2:
Practice Address - City:ULLIN
Practice Address - State:IL
Practice Address - Zip Code:62992-1014
Practice Address - Country:US
Practice Address - Phone:618-634-9800
Practice Address - Fax:618-634-9864
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2680172103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool