MEDICARE: HALEY DAWN MILHOLLAND LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	34009833A	IN

General Provider Information

NPI Number	:	1164159695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY DAWN MILHOLLAND LCSW

Provider Business Mailing Address
First Line	:	8905 BRAGG RD
Second Line	:
City	:	FOUNTAIN CITY
State	:	IN
Zip	:	47341-9769
Country	:	US
Telephone Number	:	765-499-7539
Fax Number	:

Provider Business Practice Location Address
First Line	:	8905 BRAGG RD
Second Line	:
City	:	FOUNTAIN CITY
State	:	IN
Zip	:	47341-9769
Country	:	US
Telephone Number	:	765-499-7539
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2022
Last Update Date	:	08/04/2022

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