Provider Demographics
NPI:1972144103
Name:POLITTE, HAILEY
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:POLITTE
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 1:29 BLACKMORE RD
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:MO
Mailing Address - Zip Code:63347-3001
Mailing Address - Country:US
Mailing Address - Phone:636-290-1974
Mailing Address - Fax:
Practice Address - Street 1:105 SW EAGLES PKWY
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-8512
Practice Address - Country:US
Practice Address - Phone:816-265-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-29
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician