Healthcare Provider Details

I. General information

NPI: 1215482666
Provider Name (Legal Business Name): HALEY NICOLE HARDIN QMHA, THW, YPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 GATEWAY LOOP STE 200
SPRINGFIELD OR
97477-7706
US

IV. Provider business mailing address

1144 GATEWAY LOOP STE 200
SPRINGFIELD OR
97477-7706
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-5060
  • Fax: 541-343-6938
Mailing address:
  • Phone: 541-686-5060
  • Fax: 541-343-6938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: