Provider Demographics
NPI:1821486192
Name:HARE, DALLON
Entity Type:Individual
Prefix:
First Name:DALLON
Middle Name:
Last Name:HARE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 YANKEE DR
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8982
Mailing Address - Country:US
Mailing Address - Phone:509-492-8244
Mailing Address - Fax:
Practice Address - Street 1:6711 YANKEE DR
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-8982
Practice Address - Country:US
Practice Address - Phone:509-492-8244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60493945171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator