Provider Demographics
NPI:1538624424
Name:HALEY, ALLISON
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:HALEY
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 1:1200 W CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-1818
Mailing Address - Country:US
Mailing Address - Phone:989-898-8538
Mailing Address - Fax:
Practice Address - Street 1:1200 W CEDAR AVE
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-1818
Practice Address - Country:US
Practice Address - Phone:989-254-6427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2025-10-14
Deactivation Date:2025-09-16
Deactivation Code:
Reactivation Date:2025-10-01
Provider Licenses
StateLicense IDTaxonomies
MI4704388859363L00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician