MEDICARE: MS. SHANNON MICHELLE MADSEN M.A.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1487968145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANNON MICHELLE MADSEN M.A.

Provider Business Mailing Address
First Line	:	9830 NE CASCADES PKWY
Second Line	:	STE. 200
City	:	PORTLAND
State	:	OR
Zip	:	97220-6832
Country	:	US
Telephone Number	:	503-400-0654
Fax Number	:

Provider Business Practice Location Address
First Line	:	9830 NE CASCADES PKWY
Second Line	:	STE. 200
City	:	PORTLAND
State	:	OR
Zip	:	97220-6832
Country	:	US
Telephone Number	:	503-400-0654
Fax Number	:

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

Provider Enumeration Date	:	08/04/2010
Last Update Date	:	05/27/2011

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