Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | RW5154 | CA |
NPI | 1003256231 |
---|---|
Provider Name | Mrs. Leanne Maylene Hake |
First Address | North Bend, OR 97459-3477 |
Second Address | North Bend, OR 97459-3477 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2013 |
Last Update Date | 07/01/2022 |