Basic Information
| Provider Information | |||||||||
| NPI: | 1609496280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDEREGG | ||||||||
| FirstName: | HAILEY | ||||||||
| MiddleName: | N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 TRABAR DRIVE | ||||||||
| Address2: | SPRINGS 22 | ||||||||
| City: | SAINT CLAIRSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4847676199 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 NOBLE DR | ||||||||
| Address2: | |||||||||
| City: | WOOSTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446915353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302643232 | ||||||||
| FaxNumber: | 3302643879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2020 | ||||||||
| LastUpdateDate: | 08/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CDCA.162673 | OH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | S.2005525 | OH | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 104100000X | S.2005525 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.