Healthcare Provider Details

I. General information

NPI: 1306321617
Provider Name (Legal Business Name): CALEB JOHN HALLAUER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 KINGSBURY ST
MAUMEE OH
43537-1865
US

IV. Provider business mailing address

3141 SCOTT RD
SWANTON OH
43558-9419
US

V. Phone/Fax

Practice location:
  • Phone: 567-218-0185
  • Fax: 419-930-6721
Mailing address:
  • Phone: 567-218-0185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number08943
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: