Provider Demographics
NPI:1215701008
Name:CUSACK, HALEE ELIZABETH
Entity type:Individual
Prefix:
First Name:HALEE
Middle Name:ELIZABETH
Last Name:CUSACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HALEE
Other - Middle Name:ELIZABETH
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8237 WOODSTONE DR SE
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-8480
Mailing Address - Country:US
Mailing Address - Phone:616-648-3959
Mailing Address - Fax:
Practice Address - Street 1:5924 CROSSMOOR ST
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-8555
Practice Address - Country:US
Practice Address - Phone:616-648-3959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered