Provider Demographics
NPI:1962086843
Name:STALMACK, HALEE
Entity type:Individual
Prefix:
First Name:HALEE
Middle Name:
Last Name:STALMACK
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 1:5281 CLYDE PARK AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-9506
Mailing Address - Country:US
Mailing Address - Phone:616-719-5462
Mailing Address - Fax:
Practice Address - Street 1:3809 LAKE EASTBROOK BLVD SE STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5931
Practice Address - Country:US
Practice Address - Phone:489-261-6604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician