Healthcare Provider Details

I. General information

NPI: 1902312481
Provider Name (Legal Business Name): SOFYA HADLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOFYA DYBAL

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19919 BARTLETT RD
BOTHELL WA
98012-9645
US

IV. Provider business mailing address

3000 EL CAMINO REAL BLDG 4
PALO ALTO CA
94306-2100
US

V. Phone/Fax

Practice location:
  • Phone: 628-250-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-61371565
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number10216942
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number10185344
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: