Healthcare Provider Details

I. General information

NPI: 1558739300
Provider Name (Legal Business Name): HAYLEY SHILLING PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6602 GRAND TETON PLZ STE 100
MADISON WI
53719-2905
US

IV. Provider business mailing address

1118 PROFESSIONAL DR
DODGEVILLE WI
53533-1176
US

V. Phone/Fax

Practice location:
  • Phone: 608-828-3636
  • Fax: 608-828-3637
Mailing address:
  • Phone: 608-935-2838
  • Fax: 608-935-9227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3256
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: