Provider Demographics
NPI:1164906574
Name:STEVENSON, HAYLIE REBECCA
Entity Type:Individual
Prefix:
First Name:HAYLIE
Middle Name:REBECCA
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25261 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49112-9432
Mailing Address - Country:US
Mailing Address - Phone:269-228-2039
Mailing Address - Fax:
Practice Address - Street 1:25261 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:EDWARDSBURG
Practice Address - State:MI
Practice Address - Zip Code:49112-9432
Practice Address - Country:US
Practice Address - Phone:269-228-2039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist