Provider Demographics
NPI:1255005773
Name:CAUDLE, HAILEY ELISABETH (MS)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:ELISABETH
Last Name:CAUDLE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16340 NE 83RD ST APT E127
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3879
Mailing Address - Country:US
Mailing Address - Phone:208-569-9629
Mailing Address - Fax:
Practice Address - Street 1:6901 SAND POINT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-7869
Practice Address - Country:US
Practice Address - Phone:206-987-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-07
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAPY61380257103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program