Individual
RANDY HATHAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
401 E 3RD ST, SUIT 101, THE DALLES, OR 97058-2562
(503) 369-4049
Mailing address
401 E 3RD ST, SUIT 101, THE DALLES, OR 97058-2562
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
OR
Other
Enumeration date
09/09/2016
Last updated
09/09/2016
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