Healthcare Provider Details

I. General information

NPI: 1932700028
Provider Name (Legal Business Name): HAYLEY BOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 ELKRIDGE LANDING RD STE 350
LINTHICUM HEIGHTS MD
21090-2953
US

IV. Provider business mailing address

33458 N MILL RD
GRAYSLAKE IL
60030-1951
US

V. Phone/Fax

Practice location:
  • Phone: 443-354-8903
  • Fax:
Mailing address:
  • Phone: 541-892-1874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: