Healthcare Provider Details

I. General information

NPI: 1841008083
Provider Name (Legal Business Name): HAYLIE RAY VALDIVIA-JOHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3857 MARTIN WAY E
OLYMPIA WA
98506-5268
US

IV. Provider business mailing address

24 EVERGREEN VILLAGE LN
ELMA WA
98541-9218
US

V. Phone/Fax

Practice location:
  • Phone: 360-704-7170
  • Fax: 360-709-4374
Mailing address:
  • Phone: 360-589-0504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: