Provider Demographics
NPI:1982243531
Name:FELLOWS, HALEY ANNE
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:ANNE
Last Name:FELLOWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 SE HAWTHORNE BLVD APT 108
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3264
Mailing Address - Country:US
Mailing Address - Phone:503-830-3452
Mailing Address - Fax:
Practice Address - Street 1:4929 SE HAWTHORNE BLVD APT 108
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3264
Practice Address - Country:US
Practice Address - Phone:503-830-3452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-B-10224792103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst