Provider Demographics
NPI:1619148970
Name:HADLEY, REGINA MARLENE (CSAC)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MARLENE
Last Name:HADLEY
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 LAKE AVE
Mailing Address - Street 2:101
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1566
Mailing Address - Country:US
Mailing Address - Phone:262-634-8688
Mailing Address - Fax:262-634-7547
Practice Address - Street 1:840 LAKE AVE
Practice Address - Street 2:101
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1566
Practice Address - Country:US
Practice Address - Phone:262-634-8688
Practice Address - Fax:262-634-7547
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10875-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39387600Medicaid