Individual
HALEY LODEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1318 PLANTATION RD NE, ROANOKE, VA 24012-5713
(540) 355-8599
Mailing address
1318 PLANTATION RD NE, ROANOKE, VA 24012-5713
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
N/A
VA
Enumeration date
08/10/2022
Last updated
08/10/2022
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