Healthcare Provider Details

I. General information

NPI: 1063244903
Provider Name (Legal Business Name): CAROLINE SUESANN HAYES ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 ULLIN AVE
ULLIN IL
62992-1014
US

IV. Provider business mailing address

751 ULLIN AVE
ULLIN IL
62992-1014
US

V. Phone/Fax

Practice location:
  • Phone: 618-634-9800
  • Fax: 618-634-9864
Mailing address:
  • Phone: 618-634-9800
  • Fax: 618-634-9864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2680172
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: