Healthcare Provider Details

I. General information

NPI: 1285495804
Provider Name (Legal Business Name): HALEY MAENNCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 VICTOR AVE STE A
REDDING CA
96002-1447
US

IV. Provider business mailing address

PO BOX 950
RED BLUFF CA
96080-0950
US

V. Phone/Fax

Practice location:
  • Phone: 530-722-1022
  • Fax: 530-722-1058
Mailing address:
  • Phone: 530-528-2938
  • Fax: 530-528-8034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number133102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: