Provider Demographics
NPI:1457540809
Name:SHADDAY, ALLISON ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:ANN
Last Name:SHADDAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61558 DEVILS LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9150
Mailing Address - Country:US
Mailing Address - Phone:808-469-7623
Mailing Address - Fax:808-263-3655
Practice Address - Street 1:61558 DEVILS LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-9150
Practice Address - Country:US
Practice Address - Phone:808-469-7623
Practice Address - Fax:808-263-3655
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000081411041C0700X
OR107521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR105177Medicare PIN