Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | A3735496 | CA |
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 10-R-06 | OR |
NPI | 1427351436 |
---|---|
Provider Name | Jo Anne Shields |
First Address | Albany, OR 97322-8910 |
Second Address | Corvallis, OR 97330-5223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2010 |
Last Update Date | 13/12/2010 |