Healthcare Provider Details

I. General information

NPI: 1255295481
Provider Name (Legal Business Name): HAYLEY ISHIHARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2266 N PROSPECT AVE STE 304
MILWAUKEE WI
53202-6306
US

IV. Provider business mailing address

3425 S CHASE AVE
MILWAUKEE WI
53207-3347
US

V. Phone/Fax

Practice location:
  • Phone: 414-323-5833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number8742-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: