Provider Demographics
NPI:1508541335
Name:CERISE, HAILEY NICOLE
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:NICOLE
Last Name:CERISE
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 1:624 S GLENDALE ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-2433
Mailing Address - Country:US
Mailing Address - Phone:801-330-4675
Mailing Address - Fax:
Practice Address - Street 1:70 N MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6115
Practice Address - Country:US
Practice Address - Phone:801-298-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10831010-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical