Provider Demographics
NPI:1881319457
Name:PENROD, HAILEY
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:PENROD
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:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-0102
Mailing Address - Country:US
Mailing Address - Phone:319-559-1065
Mailing Address - Fax:319-575-6065
Practice Address - Street 1:506 E BREMER AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-1748
Practice Address - Country:US
Practice Address - Phone:319-559-1065
Practice Address - Fax:319-575-6065
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health