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General NPI Number Information
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NPI Number | 1225515844
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Entity Type | Individual
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Provider Name | ANN MARIE SHODDY AAC,CPC,CDPT,BAE
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Gender | Female
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 1302 COMMERCE AVE
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City | LONGVIEW
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State | WA
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Zip | 98632-3096
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Country | US
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Telephone | 360-423-2806
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Fax |
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Provider Business Mailing Address
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Address Line | 1302 COMMERCE AVE
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City | LONGVIEW
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State | WA
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Zip | 98632-3096
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Country | US
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Telephone | 360-423-2806
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | CG60858312
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CO60823685
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CG60858312
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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