Provider Demographics
NPI:1881817914
Name:ANDERSON, HALEY (LMP)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4643
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98063-4643
Mailing Address - Country:US
Mailing Address - Phone:253-927-9382
Mailing Address - Fax:253-661-3284
Practice Address - Street 1:32015 1ST AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5701
Practice Address - Country:US
Practice Address - Phone:253-927-9382
Practice Address - Fax:253-661-3284
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022362174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist