Healthcare Provider Details

I. General information

NPI: 1215584776
Provider Name (Legal Business Name): PATRICIA RENEE SHIMEK MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE SHIMEK MS

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E POWELL BLVD
GRESHAM OR
97080-1365
US

IV. Provider business mailing address

1490 SW 21ST TER
GRESHAM OR
97080-6613
US

V. Phone/Fax

Practice location:
  • Phone: 503-669-4300
  • Fax: 503-669-4301
Mailing address:
  • Phone: 503-730-2284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: