Provider Demographics
NPI:1306551924
Name:LANDEWEE, HALEY (ATC)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:LANDEWEE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:404 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-4413
Mailing Address - Country:US
Mailing Address - Phone:618-559-0889
Mailing Address - Fax:
Practice Address - Street 1:900 E WALNUT ST STE 1
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3132
Practice Address - Country:US
Practice Address - Phone:618-319-7542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190150732255A2300X
IL0960047532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer