Provider Demographics
NPI:1982244299
Name:SENDERAK, HALEY ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:HALEY
Middle Name:ELIZABETH
Last Name:SENDERAK
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:ELMINA WHITE HONORS HALL ROOM 435C PO BOX 1700
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163
Mailing Address - Country:US
Mailing Address - Phone:360-304-3752
Mailing Address - Fax:
Practice Address - Street 1:1132 BOISTFORT RD
Practice Address - Street 2:
Practice Address - City:CURTIS
Practice Address - State:WA
Practice Address - Zip Code:98538-9726
Practice Address - Country:US
Practice Address - Phone:360-304-3752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWDL18B44G63B390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program