Provider Demographics
NPI:1023236544
Name:HADLEY, KELLY R (LICSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:R
Last Name:HADLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 NW LOWELL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7851
Mailing Address - Country:US
Mailing Address - Phone:360-698-8980
Mailing Address - Fax:360-698-8950
Practice Address - Street 1:3501 NW LOWELL ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7851
Practice Address - Country:US
Practice Address - Phone:360-698-8980
Practice Address - Fax:360-698-8950
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000054451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical