Provider Demographics
NPI:1417563818
Name:KASSEL, HALEY ANN
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:ANN
Last Name:KASSEL
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 1:1406 N 1220 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6053
Mailing Address - Country:US
Mailing Address - Phone:801-960-6338
Mailing Address - Fax:
Practice Address - Street 1:1406 N 1220 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6053
Practice Address - Country:US
Practice Address - Phone:801-960-6338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician