Provider Demographics
NPI:1689755043
Name:HADLEY, RAYMOND L JR (MS)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:L
Last Name:HADLEY
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 CAMPUS ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53563-1750
Mailing Address - Country:US
Mailing Address - Phone:608-868-5122
Mailing Address - Fax:
Practice Address - Street 1:508 CAMPUS ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MILTON
Practice Address - State:WI
Practice Address - Zip Code:53563-1750
Practice Address - Country:US
Practice Address - Phone:608-868-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI396-40-700Medicaid