MEDICARE: HALEY RUSSELL LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	13365	KS

General Provider Information

NPI Number	:	1265276422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY RUSSELL LMSW

Provider Business Mailing Address
First Line	:	1201 WAKARUSA DR STE E111
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-3913
Country	:	US
Telephone Number	:	785-218-6898
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 WAKARUSA DR STE E111
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-3913
Country	:	US
Telephone Number	:	785-246-6890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2024
Last Update Date	:	02/25/2025

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Directions to “ HALEY RUSSELL LMSW” Practice Location

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