Healthcare Provider Details

I. General information

NPI: 1407681927
Provider Name (Legal Business Name): HALEY EARLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 HEALTH SERVICES DR
DEKALB IL
60115-9637
US

IV. Provider business mailing address

PO BOX 1109
DEKALB IL
60115-7109
US

V. Phone/Fax

Practice location:
  • Phone: 815-756-4875
  • Fax:
Mailing address:
  • Phone: 815-766-3024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.130180
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: