Provider Demographics
NPI:1518515725
Name:SHIYAN, THAILER DAWN (BA)
Entity Type:Individual
Prefix:
First Name:THAILER
Middle Name:DAWN
Last Name:SHIYAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:THAILER
Other - Middle Name:DAWN
Other - Last Name:WHITLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7401 W GRANDRIDGE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7831
Mailing Address - Country:US
Mailing Address - Phone:425-368-9349
Mailing Address - Fax:
Practice Address - Street 1:7401 W GRANDRIDGE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7831
Practice Address - Country:US
Practice Address - Phone:425-368-9349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program