Provider Information for 1578958062
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DEBRA HAYES LCP
Sex: Female
NPI: 1578958062
Last Updated: 2015-04-01
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1578958062 | ||||||||
| Enumeration Date | 2015-04-01 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1414 W MAIN ST MARION, IL 62959-1142 United States Phone: 618-364-5128 | Fax: | ||||||||
| Primary Practice Address | 408 E VINE ST VIENNA, IL 62995-1612 United States Phone: 618-658-2611 | Fax: | ||||||||
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