Healthcare Provider Details

I. General information

NPI: 1205643970
Provider Name (Legal Business Name): HAILEY J ROFFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 W 13 MILE RD
ROYAL OAK MI
48073-6515
US

IV. Provider business mailing address

1128 HENDRICKSON BLVD
CLAWSON MI
48017-2308
US

V. Phone/Fax

Practice location:
  • Phone: 248-549-4339
  • Fax:
Mailing address:
  • Phone: 248-480-3577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: