Provider Demographics
NPI:1205046133
Name:HAILEY, JENNIFER LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEE
Last Name:HAILEY
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:560 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-1136
Mailing Address - Country:US
Mailing Address - Phone:608-643-3663
Mailing Address - Fax:608-643-5014
Practice Address - Street 1:2300 N MAYFAIR RD
Practice Address - Street 2:SUITE 425
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1505
Practice Address - Country:US
Practice Address - Phone:414-727-4455
Practice Address - Fax:414-727-4690
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI51010169032084P0800X
CA20A126632084P0800X
AZ0070362084P0800X
CODR.00592552084P0800X
IADO049492084P0800X
IL0361429322084P0800X
IN02004896A2084P0800X
MEDO26432084P0800X
NVDO21692084P0800X
OH34.0124892084P0800X
OK59832084P0800X
SC406202084P0800X
VA01022046802084P0800X
GA0775812084P0800X
WI54677-212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FH0532944OtherDEA
XH0532944OtherDEA- SUBOXONE