Individual
HALEY JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1725 STATE ST, 126 MITCHELL HALL, LA CROSSE, WI 54601-3742
(216) 978-1173
Mailing address
18442 HIGH PKWY, ROCKY RIVER, OH 44116-2829
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
1901-39
WI
Other
Enumeration date
02/06/2017
Last updated
02/06/2017
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