Individual
HALEY BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
266 SE 9TH ST, GRANTS PASS, OR 97526-3023
(541) 479-2550
Mailing address
1145 SW LOUISE CIR, GRANTS PASS, OR 97526-5842
(541) 660-9398
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
19306
OR
Other
Enumeration date
03/25/2014
Last updated
03/25/2014
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