Provider Demographics
NPI:1356888721
Name:KALETA, HAILEE
Entity type:Individual
Prefix:
First Name:HAILEE
Middle Name:
Last Name:KALETA
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 1:4105 N BROOKDALE PL APT 2A1
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-7458
Mailing Address - Country:US
Mailing Address - Phone:847-344-9005
Mailing Address - Fax:
Practice Address - Street 1:1428 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-9509
Practice Address - Country:US
Practice Address - Phone:309-745-5413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist