MEDICARE: BOBBI HAGUE CADC-II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	21-03-20042	OR

General Provider Information

NPI Number	:	1023731775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOBBI HAGUE CADC-II

Provider Business Mailing Address
First Line	:	213 WATER AVE NW
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-2298
Country	:	US
Telephone Number	:	541-371-2080
Fax Number	:	541-928-6713

Provider Business Practice Location Address
First Line	:	213 WATER AVE NW
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-2298
Country	:	US
Telephone Number	:	541-371-2080
Fax Number	:	541-928-6713

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2022
Last Update Date	:	09/19/2022

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