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NPI Code Detail

MEDICARE: KEVIN SHANK

MEDICARE: KEVIN SHANK
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
11041C0700XClinical Social WorkerL17410OR
2101YA0400XAddiction (Substance Use Disorder) Counselor23-11-30089OR

General Provider Information

NPI Number : 1760867659
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN SHANK
Provider Business Mailing Address
First Line : 10759 SW HERON CIR
Second Line :
City : BEAVERTON
State : OR
Zip : 97007-8353
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 33 NW BROADWAY
Second Line :
City : PORTLAND
State : OR
Zip : 97209-3580
Country : US
Telephone Number : 503-944-4410
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2015
Last Update Date : 12/01/2025

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Directions to “ KEVIN SHANK ” Practice Location

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