Provider Demographics
NPI:1821652710
Name:THOMAS, HALEY LEA (LDH ADT)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:LEA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LDH ADT
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:LEA
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LDH ADT
Mailing Address - Street 1:233 GILBERT AVE SW
Mailing Address - Street 2:
Mailing Address - City:MADELIA
Mailing Address - State:MN
Mailing Address - Zip Code:56062-1251
Mailing Address - Country:US
Mailing Address - Phone:651-500-8463
Mailing Address - Fax:
Practice Address - Street 1:115 DREW AVE SE
Practice Address - Street 2:
Practice Address - City:MADELIA
Practice Address - State:MN
Practice Address - Zip Code:56062-1873
Practice Address - Country:US
Practice Address - Phone:507-642-8742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH10214124Q00000X
MNDT109125J00000X
MNADT109125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125K00000XDental ProvidersAdvanced Practice Dental Therapist
No124Q00000XDental ProvidersDental Hygienist
No125J00000XDental ProvidersDental Therapist