Provider Demographics
NPI:1861956229
Name:FREEBERG, HAILEY (RBT-19-76572, MA)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:FREEBERG
Suffix:
Gender:F
Credentials:RBT-19-76572, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 BRIAR RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582-4408
Mailing Address - Country:US
Mailing Address - Phone:815-866-4087
Mailing Address - Fax:
Practice Address - Street 1:850 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3199
Practice Address - Country:US
Practice Address - Phone:574-267-7169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-76572106S00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician