Healthcare Provider Details

I. General information

NPI: 1528592284
Provider Name (Legal Business Name): SHAYNA CRESPO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5285 MEADOWS RD STE 170
LAKE OSWEGO OR
97035-3478
US

IV. Provider business mailing address

905 SE 14TH AVE
PORTLAND OR
97214-2569
US

V. Phone/Fax

Practice location:
  • Phone: 503-726-5216
  • Fax:
Mailing address:
  • Phone: 503-622-8964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number05-24-20422
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC6980
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: