MEDICARE: SHALONDA T HAGGERTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	NLC.0105278	CO

General Provider Information

NPI Number	:	1144710450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHALONDA T HAGGERTY

Provider Business Mailing Address
First Line	:	10758 WHEELING DR
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-7026
Country	:	US
Telephone Number	:	972-515-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2360 DAYTON ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80010-1014
Country	:	US
Telephone Number	:	972-515-5600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2018
Last Update Date	:	01/08/2021

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Directions to “ SHALONDA T HAGGERTY ” Practice Location

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