Provider Demographics
NPI:1093209934
Name:SHIELDS, HALEY BROOKE
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:BROOKE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:BROOKE
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4098 W TETON ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-6337
Mailing Address - Country:US
Mailing Address - Phone:801-560-2551
Mailing Address - Fax:
Practice Address - Street 1:4098 W TETON ESTATES DR
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-6337
Practice Address - Country:US
Practice Address - Phone:801-560-2551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0-19-10435106E00000X
106S00000X, 103K00000X
UT11608862-2507106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician