MEDICARE: SHELLEE RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	08-12-68	OR

General Provider Information

NPI Number	:	1033570692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEE RODRIGUEZ

Provider Business Mailing Address
First Line	:	1632 SW FILBERT LN
Second Line	:
City	:	DALLAS
State	:	OR
Zip	:	97338-1285
Country	:	US
Telephone Number	:	503-999-0655
Fax Number	:

Provider Business Practice Location Address
First Line	:	5061 LIBERTY RD S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97306-2073
Country	:	US
Telephone Number	:	503-363-2021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2016
Last Update Date	:	02/14/2024

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Directions to “ SHELLEE RODRIGUEZ ” Practice Location

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