Provider Demographics
NPI:1679948558
Name:HAIR, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HAIR
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 1:500 W SILVER SPRING DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5051
Mailing Address - Country:US
Mailing Address - Phone:414-336-9966
Mailing Address - Fax:
Practice Address - Street 1:500 W SILVER SPRING DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-5051
Practice Address - Country:US
Practice Address - Phone:414-336-9966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health