Provider Demographics
NPI:1932926755
Name:SPONEMAN, HAILEY
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:SPONEMAN
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 1:234 W CEDAR ST UNIT 446
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5283
Mailing Address - Country:US
Mailing Address - Phone:618-567-6941
Mailing Address - Fax:
Practice Address - Street 1:1901 PARKVIEW AVE STE 1
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-4806
Practice Address - Country:US
Practice Address - Phone:269-225-5148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023956101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health