Provider Demographics
NPI:1598309551
Name:BAGLEY, HALEY RUTH
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:RUTH
Last Name:BAGLEY
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 1:3431 THOMAS AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2251
Mailing Address - Country:US
Mailing Address - Phone:612-275-4260
Mailing Address - Fax:
Practice Address - Street 1:3843 OAKGREEN AVE N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-1331
Practice Address - Country:US
Practice Address - Phone:303-630-9239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4704106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist