Provider Demographics
NPI:1538978382
Name:HALEY, JOANNA (LAC,MSTOM, DIPL OM,)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:HALEY
Suffix:
Gender:F
Credentials:LAC,MSTOM, DIPL OM,
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 17370, LOT 3383
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117
Mailing Address - Country:US
Mailing Address - Phone:612-460-8802
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 17370, LOT 3383
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117
Practice Address - Country:US
Practice Address - Phone:612-460-8802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1824171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist