Provider Demographics
NPI:1427921832
Name:CONKLIN, HALEY DIANE
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:DIANE
Last Name:CONKLIN
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 1:1791 W STERLING RD
Mailing Address - Street 2:1791 W STERLING RD
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250-9410
Mailing Address - Country:US
Mailing Address - Phone:517-936-8116
Mailing Address - Fax:
Practice Address - Street 1:2536 SPRING ARBOR RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3602
Practice Address - Country:US
Practice Address - Phone:517-998-0999
Practice Address - Fax:517-998-0998
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty