Provider Demographics
NPI:1831864875
Name:CONKLIN, HAILEY (LMSW)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:
Other - Last Name:SANTANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:67749 S RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-9342
Mailing Address - Country:US
Mailing Address - Phone:269-252-9227
Mailing Address - Fax:
Practice Address - Street 1:955 S BAILEY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-6743
Practice Address - Country:US
Practice Address - Phone:269-637-5271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511074651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical