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General NPI Number Information
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NPI Number | 1447840301
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Entity Type | Individual
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Provider Name | SHANNON MARIE DALLEY PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 01/24/2021
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 15935 SW 146TH AVE
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City | TIGARD
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State | OR
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Zip | 97224-1380
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Country | US
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Telephone | 360-602-2563
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Fax |
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Provider Business Mailing Address
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Address Line | 15935 SW 146TH AVE
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City | TIGARD
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State | OR
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Zip | 97224-1380
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Country | US
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Telephone | 978-996-9521
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY61053793
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3620
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License Number State | OR
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