Provider Demographics
NPI:1841008083
Name:VALDIVIA-JOHN, HAYLIE RAY
Entity type:Individual
Prefix:
First Name:HAYLIE
Middle Name:RAY
Last Name:VALDIVIA-JOHN
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 1:102 S CHEHALIS ST
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-3818
Mailing Address - Country:US
Mailing Address - Phone:360-589-0504
Mailing Address - Fax:
Practice Address - Street 1:1217 COOPER POINT RD SW STE 5
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-7206
Practice Address - Country:US
Practice Address - Phone:360-464-9052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst