Healthcare Provider Details

I. General information

NPI: 1548078785
Provider Name (Legal Business Name): SHAELYN RICHELLE PARSONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 MERRITT ST
PRIEST RIVER ID
83856-6563
US

IV. Provider business mailing address

54 MERRITT ST
PRIEST RIVER ID
83856-6563
US

V. Phone/Fax

Practice location:
  • Phone: 541-240-0183
  • Fax:
Mailing address:
  • Phone: 541-240-0183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6171146
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61642753
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: