=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306921846
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHIRLEY K SHEN PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 02/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1701 E EVERGREEN BLVD
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98661-4289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-998-6238
-----------------------------------------------------
Fax | 360-326-1651
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 703 NW 151ST ST
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98685-1753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-998-6238
-----------------------------------------------------
Fax | 360-326-1651
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PY00002736
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------