Healthcare Provider Details

I. General information

NPI: 1992643696
Provider Name (Legal Business Name): SHANNON DIANE CHRISMAN CSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNON DIANE RILATOS

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 SE DORION AVE
PENDLETON OR
97801-2529
US

IV. Provider business mailing address

311 SE DORION AVE
PENDLETON OR
97801-2529
US

V. Phone/Fax

Practice location:
  • Phone: 541-272-1606
  • Fax:
Mailing address:
  • Phone: 541-272-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA15689
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberA15689
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberA15689
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: