Provider Demographics
NPI:1285313056
Name:SAVAGE, HAILY LORRAINE (RBT)
Entity type:Individual
Prefix:
First Name:HAILY
Middle Name:LORRAINE
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 N INTERLACHEN WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1015
Mailing Address - Country:US
Mailing Address - Phone:208-550-9160
Mailing Address - Fax:
Practice Address - Street 1:1861 N INTERLACHEN WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1015
Practice Address - Country:US
Practice Address - Phone:208-550-9160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRBT-23-261443106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician