Provider Demographics
NPI:1386008910
Name:WOOD, HAYLEY
Entity Type:Individual
Prefix:MISS
First Name:HAYLEY
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 SOUTHSHORE BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5570
Mailing Address - Country:US
Mailing Address - Phone:971-258-7838
Mailing Address - Fax:
Practice Address - Street 1:4311 SOUTHSHORE BLVD APT 1
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5570
Practice Address - Country:US
Practice Address - Phone:971-258-7838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-10
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
ORABA-AB-10218259106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other