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General NPI Number Information
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NPI Number | 1851750483
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Entity Type | Individual
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Provider Name | HAILEY DAWN POTTER
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Gender | Female
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Dates
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Enumeration Date | 02/10/2016
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 965 EMERSON PKWY # H1
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City | GREENWOOD
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State | IN
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Zip | 46143-6273
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Country | US
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Telephone | 855-772-8847
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Fax |
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Provider Business Mailing Address
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Address Line | 5335 E HARBOR RD
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City | FREELAND
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State | WA
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Zip | 98249-9534
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Country | US
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Telephone | 360-632-5430
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State | WA
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