Provider Demographics
NPI:1801493325
Name:SIDIE, HALEY EVELYN (CTRS)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:EVELYN
Last Name:SIDIE
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:EVELYN
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CTRS
Mailing Address - Street 1:W7628 22ND ST W
Mailing Address - Street 2:
Mailing Address - City:NECEDAH
Mailing Address - State:WI
Mailing Address - Zip Code:54646-7704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 E VETERANS ST
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-3105
Practice Address - Country:US
Practice Address - Phone:608-372-3971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI82368225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist