Provider Demographics
NPI:1114719242
Name:EDMONSON, HAILEY (SUDC)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:EDMONSON
Suffix:
Gender:F
Credentials:SUDC
Other - Prefix:MISS
Other - First Name:HAILEY
Other - Middle Name:
Other - Last Name:EDMONSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SUDC
Mailing Address - Street 1:134 W 1180 N STE 4
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-1483
Mailing Address - Country:US
Mailing Address - Phone:435-248-0333
Mailing Address - Fax:
Practice Address - Street 1:134 W 1180 N STE 4
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-1483
Practice Address - Country:US
Practice Address - Phone:434-241-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)