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General NPI Number Information
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NPI Number | 1750727483
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Entity Type | Individual
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Provider Name | JACQUELINE RIEGELHAUPT-KAMRIN SHANNON LMFT
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Gender | Female
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Dates
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Enumeration Date | 05/21/2013
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Last Update Date | 05/14/2024
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Provider Practice Location Address
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Address Line | 313 NE 79TH AVE
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City | PORTLAND
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State | OR
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Zip | 97213-7007
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Country | US
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Telephone | 619-674-9525
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Fax |
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Provider Business Mailing Address
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Address Line | 313 NE 79TH AVE
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City | PORTLAND
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State | OR
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Zip | 97213-7007
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Country | US
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Telephone | 619-674-9525
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 20-R-29
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 116706
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | T1773
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License Number State | OR
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