Active NPI
Allison Ann Shadday, LCSW
- Clinical Social Worker
- Bend, OR
National Provider Identifier
1457540809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 10752
- Practice address
- 61558 Devils Lake Drive
Bend, OR 97702-9150 - Phone
- (808) 469-7623
- Fax
- (808) 263-3655
- NPI assigned
- Oct 22, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LW00008141 | WA | |
| Clinical Social Worker | 1041C0700X | 10752 | OR | Primary |
Addresses
Primary practice location
61558 Devils Lake Drive
Bend, OR 97702-9150
Mailing address
61558 Devils Lake Drive
Bend, OR 97702-9150
Phone (808) 469-7623
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10752 | OR | MD | Clinical Social Worker |
| LW00008141 | WA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676505600000",
"number": "1457540809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "61558 DEVILS LAKE DRIVE",
"city": "BEND",
"state": "OR",
"postal_code": "977029150",
"telephone_number": "808-469-7623",
"fax_number": "808-263-3655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "61558 DEVILS LAKE DRIVE",
"city": "BEND",
"state": "OR",
"postal_code": "977029150",
"telephone_number": "808-469-7623",
"fax_number": "808-263-3655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHADDAY",
"first_name": "ALLISON",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-10-22",
"last_updated": "2023-02-16",
"certification_date": "2023-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "LW00008141",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "10752",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.