Healthcare Provider Details

I. General information

NPI: 1396663324
Provider Name (Legal Business Name): HALEY ANN SJODIN CSFA, CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 W MEDICAL CENTER DR STE B310
MCHENRY IL
60050-8441
US

IV. Provider business mailing address

32301 PRAIRIEVIEW LN
LAKEMOOR IL
60051-2241
US

V. Phone/Fax

Practice location:
  • Phone: 847-802-7090
  • Fax:
Mailing address:
  • Phone: 815-307-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: