Provider Demographics
NPI:1255221917
Name:HAYNES, LATEECE L
Entity type:Individual
Prefix:MRS
First Name:LATEECE
Middle Name:L
Last Name:HAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 27TH STREET PL NW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-6647
Mailing Address - Country:US
Mailing Address - Phone:206-330-5455
Mailing Address - Fax:206-274-6252
Practice Address - Street 1:15 S GRADY WAY STE 610
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3218
Practice Address - Country:US
Practice Address - Phone:206-679-8291
Practice Address - Fax:206-274-6252
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-05
Last Update Date:2025-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist