Provider Demographics
NPI:1215750211
Name:CRAWFORD, HAILEY JOELLE
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:JOELLE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 MIDDLEBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-3620
Mailing Address - Country:US
Mailing Address - Phone:916-764-8131
Mailing Address - Fax:
Practice Address - Street 1:5430 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-1639
Practice Address - Country:US
Practice Address - Phone:916-764-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician