Provider Demographics
NPI:1679547806
Name:HAYES DALY, JUDY (MSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:HAYES DALY
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2401
Mailing Address - Country:US
Mailing Address - Phone:231-947-5234
Mailing Address - Fax:231-947-5969
Practice Address - Street 1:814 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2401
Practice Address - Country:US
Practice Address - Phone:231-947-5234
Practice Address - Fax:231-947-5969
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010152631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0890900Medicare ID - Type Unspecified
00890900Medicare UPIN