Provider Demographics
NPI:1568257772
Name:DODDS, HAILEY
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:DODDS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2342 S COPPERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163-8036
Mailing Address - Country:US
Mailing Address - Phone:812-302-2538
Mailing Address - Fax:317-978-2703
Practice Address - Street 1:7375 W US HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-8950
Practice Address - Country:US
Practice Address - Phone:812-302-2538
Practice Address - Fax:317-978-2703
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-25-42096106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician