Healthcare Provider Details

I. General information

NPI: 1275441172
Provider Name (Legal Business Name): HAILI DEWITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41719 CAPE HORN DR
CONCRETE WA
98237-8483
US

IV. Provider business mailing address

41719 CAPE HORN DR
CONCRETE WA
98237-8483
US

V. Phone/Fax

Practice location:
  • Phone: 360-255-3890
  • Fax:
Mailing address:
  • Phone: 360-255-3890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: