Provider Demographics
NPI:1538443593
Name:HAYWARD, JANE CAROL (PSYD)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:CAROL
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 39TH AVE SW STE 304
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3805
Mailing Address - Country:US
Mailing Address - Phone:253-697-6567
Mailing Address - Fax:253-697-6547
Practice Address - Street 1:1002 39TH AVE SW STE 304
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3805
Practice Address - Country:US
Practice Address - Phone:253-677-5577
Practice Address - Fax:253-697-6547
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60216965103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1619361847Medicare NSC