NPIMap

Individual provider Active NPI

Hailey Amanda Eustice, MS, CCC-SLP

  • Speech-Language Pathologist
  • Albany, OR
National Provider Identifier
1912564147
Registry record updated May 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
16092 Issued in OR
Practice address
3615 Spicer Dr SE
Albany, OR 97322-7043
Phone
(541) 967-7551
Fax
(541) 967-5095
NPI assigned
May 22, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 16092 OR Primary

Addresses

Primary practice location

3615 Spicer Dr SE
Albany, OR 97322-7043

Mailing address

3615 Spicer Dr SE
Albany, OR 97322-7043
Phone (541) 967-7551

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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
16092ORMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mighty Oaks Children'S Therapy Center Speech-Language Pathologist Past Accepting new patients
Legacy Meridian Park Hospital Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1558483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558483200000",
    "number": "1912564147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3615 SPICER DR SE",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973227043",
            "telephone_number": "541-967-7551",
            "fax_number": "541-967-5095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 SPICER DR SE",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973227043",
            "telephone_number": "541-967-7551",
            "fax_number": "541-967-5095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EUSTICE",
        "first_name": "HAILEY",
        "middle_name": "AMANDA",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-22",
        "last_updated": "2019-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OR",
            "license": "16092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 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.