Hayden Gandolfi

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

7101007378 Issued in MI

Practice address

2715 Lilac St
Longview, WA 98632-3526

Phone

(360) 575-7000

NPI assigned

Apr 21, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Ivyrehab Michigan, LLC

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Fenton, MI
  • NPI 1104337120
  Medicare reassignment

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

{
    "created_epoch": "1650499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650499200000",
    "number": "1720722218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27077 DARTMOUTH ST",
            "city": "MADISON HEIGHTS",
            "state": "MI",
            "postal_code": "480713235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2715 LILAC ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323526",
            "telephone_number": "360-575-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANDOLFI",
        "first_name": "HAYDEN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-04-21",
        "last_updated": "2022-04-21",
        "certification_date": "2022-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": "7101007378",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Nicole Gaines
• Rachel A Gaines, SUDP
• Kortney Suanne Gallagher, CPC
• Shelly Dawn Gallaher, RPH
• Gaurav Gandhi, MD
• Daisy Garcia, AAC
• Marcus Garcia
• Martha A Garcia, MA, AAC
• Rachael Garcia
• Emily Ann Gardner, LMHC

• Speech-Language Pathologist in Longview, WA
• Providers in Longview, 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 Apr 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.