Provider Demographics
NPI:1730638230
Name:HALLER, AUDRIE ANN I
Entity Type:Individual
Prefix:
First Name:AUDRIE
Middle Name:ANN
Last Name:HALLER
Suffix:I
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 1:2890 OAK VALLEY AVE SW APT 307
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-2684
Mailing Address - Country:US
Mailing Address - Phone:616-634-4087
Mailing Address - Fax:
Practice Address - Street 1:2890 OAK VALLEY AVE SW APT 307
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-2684
Practice Address - Country:US
Practice Address - Phone:616-634-4087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-25
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor