Haley Shadoan, MS CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

LL60707476 Issued in WA

Practice address

23931 Highway 99 Unit 103
Edmonds, WA 98026-9259

Phone

(206) 751-6266

Fax

(206) 519-6695

NPI assigned

Feb 25, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Haley Dyan Fuller Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Speech Orchard, LLC

  • Hearing and Speech Clinic/Center
  • Edmonds, WA
  • NPI 1871074005
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564617600000",
    "number": "1538529144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16320 FREMONT PL N",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981335611",
            "telephone_number": "281-642-3359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23931 HIGHWAY 99 UNIT 103",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980269259",
            "telephone_number": "206-751-6266",
            "fax_number": "206-519-6695"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6405 218th St SW Ste 307",
            "address_purpose": "LOCATION",
            "city": "Mountlake Terrace",
            "state": "WA",
            "postal_code": "98043",
            "country_code": "US",
            "telephone_number": "206-751-6266",
            "fax_number": "206-519-6695",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHADOAN",
        "first_name": "HALEY",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-25",
        "last_updated": "2019-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL60707476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HALEY",
            "last_name": "FULLER",
            "middle_name": "DYAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Speech-Language Pathologist in Edmonds, WA
• Providers in Edmonds, WA by specialty
• Speech-Language Pathologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.