Provider Demographics
NPI:1043828957
Name:HADLEY, WINTER (RBT)
Entity type:Individual
Prefix:
First Name:WINTER
Middle Name:
Last Name:HADLEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 DAYBREAK DR
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-6409
Mailing Address - Country:US
Mailing Address - Phone:855-690-2192
Mailing Address - Fax:888-972-2192
Practice Address - Street 1:2104 DAYBREAK DR
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-6409
Practice Address - Country:US
Practice Address - Phone:855-690-2192
Practice Address - Fax:888-972-2192
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-19-92205106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty