Provider Demographics
NPI:1003256231
Name:HAKE, LEANNE MAYLENE (CADCII)
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:MAYLENE
Last Name:HAKE
Suffix:
Gender:F
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 WAITE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-1228
Mailing Address - Country:US
Mailing Address - Phone:541-622-0020
Mailing Address - Fax:
Practice Address - Street 1:1950 WAITE ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-1228
Practice Address - Country:US
Practice Address - Phone:541-266-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARW5154101YA0400X
101YA0400X
OR21-09-20104101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)