Derek Headley, MS CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2910 Issued in ID

Practice address

2704 NE 8TH Ave
Wilton Manors, FL 33334

Phone

(954) 218-2184

NPI assigned

May 24, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1243123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533081600000",
    "number": "1679708358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2704 NE 8TH AVE",
            "city": "WILTON MANORS",
            "state": "FL",
            "postal_code": "333342654",
            "telephone_number": "954-218-2184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2704 NE 8TH AVE",
            "city": "WILTON MANORS",
            "state": "FL",
            "postal_code": "33334",
            "telephone_number": "954-218-2184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEADLEY",
        "first_name": "DEREK",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-24",
        "last_updated": "2018-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "10739",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WV",
            "license": "1789",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ID",
            "license": "2910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Halcyon Health
• James Haley
• Jesse Seth Hammel, D.O.M.
• Katalin Hanana, MS
• Clayton James Harrison Jr., LMHC, LMFT, MCAP
• Healing Hands Zerenity, Inc
• Healthcare Solutions, LLC
• Scott Peter Heichman, MSN, APRN, FNP-C
• Steven David Herman, M.D.
• Groslamy Hernandez Vega

• Speech-Language Pathologist in Wilton Manors, FL
• Providers in Wilton Manors, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2018; 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.