Provider Demographics
NPI:1063728590
Name:HIRSCH, HALEY LYN (LMP, CMLDT)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:LYN
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:LMP, CMLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 CORDOVA ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3715
Mailing Address - Country:US
Mailing Address - Phone:907-375-0930
Mailing Address - Fax:907-375-0960
Practice Address - Street 1:626 CORDOVA ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3715
Practice Address - Country:US
Practice Address - Phone:907-375-0930
Practice Address - Fax:907-375-0960
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-22
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK905073225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist