Healthcare Provider Details

I. General information

NPI: 1447804513
Provider Name (Legal Business Name): SHANNON LEIGH HUGHES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2019
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 SW MORRISON ST STE 310
PORTLAND OR
97205-1945
US

IV. Provider business mailing address

1411 SW MORRISON ST STE 310
PORTLAND OR
97205-1945
US

V. Phone/Fax

Practice location:
  • Phone: 503-352-2400
  • Fax: 971-266-2955
Mailing address:
  • Phone: 503-352-2400
  • Fax: 971-266-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: