Healthcare Provider Details

I. General information

NPI: 1225515844
Provider Name (Legal Business Name): ANN MARIE SHODDY AAC,CPC,CDPT,BAE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 COMMERCE AVE
LONGVIEW WA
98632-3096
US

IV. Provider business mailing address

1302 COMMERCE AVE
LONGVIEW WA
98632-3096
US

V. Phone/Fax

Practice location:
  • Phone: 360-423-2806
  • Fax:
Mailing address:
  • Phone: 360-423-2806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberCG60858312
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO60823685
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60858312
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: