Provider Demographics
NPI:1023113909
Name:HALLEY, COLLEEN M (LICSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:HALLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 MOONLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-8537
Mailing Address - Country:US
Mailing Address - Phone:651-714-8007
Mailing Address - Fax:
Practice Address - Street 1:7650 CURRELL BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2257
Practice Address - Country:US
Practice Address - Phone:651-714-8007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN82451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical