Individual
MR. CODY HAYCOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
107 ISLAND AVE, LA GRANDE, OR 97850-2940
(541) 304-3205
Mailing address
2403 RIDDLE RD UNIT 10, LA GRANDE, OR 97850-5336
(541) 304-3205
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
25-CRM-4805
OR
Other
Enumeration date
12/15/2025
Last updated
04/27/2026
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