Healthcare Provider Details

I. General information

NPI: 1447131115
Provider Name (Legal Business Name): HAYLEY JANSSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N BASSETT ST APT 503
MADISON WI
53703-2924
US

IV. Provider business mailing address

212 N BASSETT ST APT 503
MADISON WI
53703-2924
US

V. Phone/Fax

Practice location:
  • Phone: 630-347-6768
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: