Provider Demographics
NPI:1760700447
Name:ROE, HADLEY ALAYNE (BS)
Entity Type:Individual
Prefix:
First Name:HADLEY
Middle Name:ALAYNE
Last Name:ROE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:HADLEY
Other - Middle Name:ALAYNE
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2090 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-9791
Mailing Address - Country:US
Mailing Address - Phone:541-991-3122
Mailing Address - Fax:
Practice Address - Street 1:3995 MARCOLA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-7948
Practice Address - Country:US
Practice Address - Phone:541-726-1465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9678008101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health