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NPI Code Detail

MEDICARE: HALEY ATENCIO BA, LADC

MEDICARE: HALEY ATENCIO BA, LADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor305463MN

General Provider Information

NPI Number : 1295302875
Entity Type Code : Individual
Provider Name (Legal Business Name) : HALEY ATENCIO BA, LADC
Provider Business Mailing Address
First Line : 604 5TH ST SW
Second Line :
City : ROCHESTER
State : MN
Zip : 55902-3256
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 604 5TH ST SW
Second Line :
City : ROCHESTER
State : MN
Zip : 55902-3256
Country : US
Telephone Number : 507-225-1800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2021
Last Update Date : 06/10/2021

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Directions to “ HALEY ATENCIO BA, LADC” Practice Location

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