Healthcare Provider Details

I. General information

NPI: 1518898097
Provider Name (Legal Business Name): HAILI ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N SUPERIOR AVE STE 1
TOMAH WI
54660-1589
US

IV. Provider business mailing address

601 N SUPERIOR AVE STE 1
TOMAH WI
54660-1589
US

V. Phone/Fax

Practice location:
  • Phone: 608-205-8860
  • Fax: 608-506-1114
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: