Healthcare Provider Details

I. General information

NPI: 1902714884
Provider Name (Legal Business Name): HALEY KLANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 FRONT ST NE
SALEM OR
97301-0775
US

IV. Provider business mailing address

17925 SW ROSA RD APT 26
BEAVERTON OR
97078-3245
US

V. Phone/Fax

Practice location:
  • Phone: 503-504-2103
  • Fax:
Mailing address:
  • Phone: 810-986-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberR10150
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: