Provider Demographics
NPI:1043398985
Name:HAYES KANE, STACY (MSW)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:HAYES KANE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 3RD AVENUE
Mailing Address - Street 2:SUITE 512
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-8000
Mailing Address - Country:US
Mailing Address - Phone:309-786-4491
Mailing Address - Fax:309-786-0205
Practice Address - Street 1:1800 3RD AVENUE
Practice Address - Street 2:SUITE 512
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-8000
Practice Address - Country:US
Practice Address - Phone:309-786-4491
Practice Address - Fax:309-786-0205
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional