Healthcare Provider Details

I. General information

NPI: 1629998638
Provider Name (Legal Business Name): EMILY RAINE HALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 3RD AVE
JASPER IN
47546-3602
US

IV. Provider business mailing address

1110 N RED ROOF DR
HUNTINGBURG IN
47542-9812
US

V. Phone/Fax

Practice location:
  • Phone: 812-670-9442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: