Healthcare Provider Details

I. General information

NPI: 1740611458
Provider Name (Legal Business Name): MR. WILLIAM ALLEN HADEN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: WILLIAM ALLEN HADEN JR. LCSW

II. Dates (important events)

Enumeration Date: 12/05/2013
Last Update Date: 09/08/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 N. ROSE STREET
PHOENIX OR
97535
US

IV. Provider business mailing address

931 CHEVY WAY
MEDFORD OR
97504-4127
US

V. Phone/Fax

Practice location:
  • Phone: 541-535-3287
  • Fax:
Mailing address:
  • Phone: 541-690-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL4655
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: