Healthcare Provider Details

I. General information

NPI: 1912426602
Provider Name (Legal Business Name): HAILEY MYRITA ALLISON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HERITAGE WAY STE 102
KALISPELL MT
59901-3127
US

IV. Provider business mailing address

14954 N COEUR DALENE ST
RATHDRUM ID
83858-6484
US

V. Phone/Fax

Practice location:
  • Phone: 406-758-3244
  • Fax: 406-758-5166
Mailing address:
  • Phone: 208-687-0538
  • Fax: 208-687-3185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number62225
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: