Healthcare Provider Details

I. General information

NPI: 1376119388
Provider Name (Legal Business Name): HALEY CHEYENNE BOLINGER-HOPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 FALLS DR
FORT WAYNE IN
46804-7147
US

IV. Provider business mailing address

10271 ERWIN LN
NEW HAVEN IN
46774-2289
US

V. Phone/Fax

Practice location:
  • Phone: 260-702-9898
  • Fax:
Mailing address:
  • Phone: 260-444-6143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: