Provider Demographics
NPI:1881198232
Name:CROOK, HALEY
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:CROOK
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 1:2143 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-1309
Mailing Address - Country:US
Mailing Address - Phone:937-508-3742
Mailing Address - Fax:
Practice Address - Street 1:4646 TAMARACK BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6566
Practice Address - Country:US
Practice Address - Phone:614-926-9229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-07-10
Deactivation Date:2018-06-13
Deactivation Code:
Reactivation Date:2018-07-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator