Provider Demographics
NPI:1518059583
Name:HAYLE, MITCHELL GRANT
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:GRANT
Last Name:HAYLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16166 WILKEY LOOP RD NE
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-6417
Mailing Address - Country:US
Mailing Address - Phone:218-444-7148
Mailing Address - Fax:
Practice Address - Street 1:722 FIFTEENTH STREET NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601
Practice Address - Country:US
Practice Address - Phone:218-751-3280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker