Provider Demographics
NPI:1881481422
Name:HESGARD, DELAYNE R
Entity type:Individual
Prefix:
First Name:DELAYNE
Middle Name:R
Last Name:HESGARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 NE 121ST AVE UNIT 6
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-6164
Mailing Address - Country:US
Mailing Address - Phone:360-901-5616
Mailing Address - Fax:
Practice Address - Street 1:305 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-9396
Practice Address - Country:US
Practice Address - Phone:360-803-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61670259225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist