Provider Information for 1316278427
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MICHELLE SHANNON LPC
Sex: Female
NPI: 1316278427
Last Updated: 2024-10-21
Certification Date: 2024-10-21
Certification Date: 2024-10-21
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1316278427 | ||||||||||||
| Enumeration Date | 2010-01-29 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | PO BOX 100 ALBANY, OR 97321-0031 United States Phone: 541-967-3819 | Fax:541-967-7259 | ||||||||||||
| Primary Practice Address | 104 4TH AVE SW ROOM 238 ALBANY, OR 97321-2804 United States Phone: 541-967-3819 | Fax:541-967-7259 | ||||||||||||
| Secondary Practice Address(es) | 355 HIGH ST SE | ||||||||||||
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