Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003007915 |
---|---|
Provider Name | Shannon Marie Beard |
First Address | Milwaukie, OR 97222-7058 |
Second Address | Milwaukie, OR 97222-7058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 06/08/2007 |