Healthcare Provider Details

I. General information

NPI: 1306581707
Provider Name (Legal Business Name): HAILEY G HUSETH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 8TH ST NW
ROCHESTER MN
55901-6817
US

IV. Provider business mailing address

3146 SOGN VALLEY TRL
DENNISON MN
55018-7749
US

V. Phone/Fax

Practice location:
  • Phone: 507-289-4031
  • Fax:
Mailing address:
  • Phone: 507-301-4767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: