Provider Demographics
NPI:1265114284
Name:BRADSHAW, HAILEE MALIN (LCSW)
Entity type:Individual
Prefix:
First Name:HAILEE
Middle Name:MALIN
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HAILEE
Other - Middle Name:
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:MO
Mailing Address - Zip Code:64857-0105
Mailing Address - Country:US
Mailing Address - Phone:417-499-5125
Mailing Address - Fax:
Practice Address - Street 1:409 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:MO
Practice Address - Zip Code:64857-8139
Practice Address - Country:US
Practice Address - Phone:417-499-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200247821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical