Healthcare Provider Details

I. General information

NPI: 1255005773
Provider Name (Legal Business Name): HAILEY ELISABETH CAUDLE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2021
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7507 NE 51ST ST
VANCOUVER WA
98662-6007
US

IV. Provider business mailing address

7507 NE 51ST ST
VANCOUVER WA
98662-6007
US

V. Phone/Fax

Practice location:
  • Phone: 360-906-1190
  • Fax:
Mailing address:
  • Phone: 360-906-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4080
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY61380257
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: