Provider Demographics
NPI:1336745116
Name:WELDEN, HALEY JEAN (DACM, LAC)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:JEAN
Last Name:WELDEN
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14718 MOSSWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-7981
Mailing Address - Country:US
Mailing Address - Phone:530-559-1338
Mailing Address - Fax:
Practice Address - Street 1:206 SACRAMENTO ST STE 202
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2633
Practice Address - Country:US
Practice Address - Phone:530-559-1338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18943171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist