Provider Demographics
NPI:1962865485
Name:SIMON, HAYLEY (LAC)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6618 SE MITCHELL CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5332
Mailing Address - Country:US
Mailing Address - Phone:949-637-7468
Mailing Address - Fax:
Practice Address - Street 1:1135 SE SALMON ST STE 108
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2695
Practice Address - Country:US
Practice Address - Phone:949-637-7468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21636225700000X
ORAC196866171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist