Park, Shannon Elaine
Park, Shannon Elaine is an sole proprietor health care provider with primary practice located at 145 S, Holly Street Suite A, Medford OR 97501-3101. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Park, Shannon Elaine can be contacted via phone (541) 773-5664.Contact Information
Primary practice address
145 S, Holly Street Suite A
Medford OR 97501-3101
Phone: (541) 773-5664
Fax: (541) 773-5667
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | L3339 | Oregon |
Profile Details
| NPI number | 1194851808 |
|---|---|
| LBN Legal business name | Park, Shannon Elaine |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 26th, 2007 |
| Last updated | Aug 13th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194851808 | NPPES |
| Oregon | Other | L3339 | LICENSE NUMBER |
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