Provider Demographics
NPI:1457042699
Name:BUDIAC, HALEY
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:BUDIAC
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 1:5861 WAUSAUKEE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-8104
Mailing Address - Country:US
Mailing Address - Phone:414-587-6625
Mailing Address - Fax:
Practice Address - Street 1:N88W16644 APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2853
Practice Address - Country:US
Practice Address - Phone:414-587-6625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2017-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist