Provider Demographics
NPI:1265281943
Name:HAFNER, MARY BETH
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:BETH
Last Name:HAFNER
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 1:623 N BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-1390
Mailing Address - Country:US
Mailing Address - Phone:708-207-1688
Mailing Address - Fax:
Practice Address - Street 1:10501 EMILIE LN
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8872
Practice Address - Country:US
Practice Address - Phone:708-326-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach