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NPI Code Detail

MEDICARE: ALLISON RAE HAYNES LLMSW

MEDICARE: ALLISON RAE HAYNES LLMSW
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
1104100000XSocial Worker6801098706MI

General Provider Information

NPI Number : 1649622747
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLISON RAE HAYNES LLMSW
Provider Business Mailing Address
First Line : 1651 E NICKERSON AVE
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-2469
Country : US
Telephone Number : 269-983-5833
Fax Number :
Provider Business Practice Location Address
First Line : 1651 E NICKERSON AVE
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-2469
Country : US
Telephone Number : 269-983-5833
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2016
Last Update Date : 07/13/2016

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