Provider Demographics
NPI:1609908904
Name:HIGHEAGLE, BILLIE M (SPEECH-LANGPATHOLOG)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:M
Last Name:HIGHEAGLE
Suffix:
Gender:F
Credentials:SPEECH-LANGPATHOLOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 N STATE ROUTE 106
Mailing Address - Street 2:
Mailing Address - City:SKOKOMISH NATION
Mailing Address - State:WA
Mailing Address - Zip Code:98584-7430
Mailing Address - Country:US
Mailing Address - Phone:360-426-2233
Mailing Address - Fax:
Practice Address - Street 1:21 NIEDERMAN ROAD
Practice Address - Street 2:
Practice Address - City:OAKVILLE
Practice Address - State:WA
Practice Address - Zip Code:68568
Practice Address - Country:US
Practice Address - Phone:360-858-1660
Practice Address - Fax:360-273-2723
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003844235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7126931Medicaid
WALL00003844OtherSTATE LICENSE