MEDICARE: MS. ELIZABETH ANNE SHIELDS M. ED

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	106H00000X	Marriage & Family Therapist	0766	OR

General Provider Information

NPI Number	:	1053489971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH ANNE SHIELDS M. ED

Provider Business Mailing Address
First Line	:	711 RAMSEY AVE
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97527
Country	:	US
Telephone Number	:	541-476-3302
Fax Number	:

Provider Business Practice Location Address
First Line	:	7180 SW FIR LOOP
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-8023
Country	:	US
Telephone Number	:	503-639-3009
Fax Number	:

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	01/06/2020

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