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NPI Code Detail

MEDICARE: DR. JENNIFER ANN SHAVER PH.D.

MEDICARE: DR. JENNIFER ANN SHAVER PH.D.
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
1103TC0700XClinical PsychologistPSY-2189HI
2103TC0700XClinical Psychologist40276TX
3103TC0700XClinical PsychologistPY60629123WA

General Provider Information

NPI Number : 1134995186
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER ANN SHAVER PH.D.
Provider Business Mailing Address
First Line : 5100 S MACADAM AVE STE 350
Second Line :
City : PORTLAND
State : OR
Zip : 97239-3877
Country : US
Telephone Number : 503-231-7854
Fax Number :
Provider Business Practice Location Address
First Line : 5100 S MACADAM AVE STE 350
Second Line :
City : PORTLAND
State : OR
Zip : 97239-3877
Country : US
Telephone Number : 503-231-7854
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2023
Last Update Date : 05/19/2026

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Directions to “ DR. JENNIFER ANN SHAVER PH.D.” Practice Location

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