Provider Demographics
NPI:1538529144
Name:SHADOAN, HALEY (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:SHADOAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:DYAN
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16320 FREMONT PL N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5611
Mailing Address - Country:US
Mailing Address - Phone:281-642-3359
Mailing Address - Fax:
Practice Address - Street 1:23931 HIGHWAY 99 UNIT 103
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-9259
Practice Address - Country:US
Practice Address - Phone:206-751-6266
Practice Address - Fax:206-519-6695
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60707476235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist