Provider Demographics
NPI:1306921846
Name:SHEN, SHIRLEY K (PHD)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:K
Last Name:SHEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 NW 151ST ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-1753
Mailing Address - Country:US
Mailing Address - Phone:503-998-6238
Mailing Address - Fax:360-326-1651
Practice Address - Street 1:1701 E EVERGREEN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-4289
Practice Address - Country:US
Practice Address - Phone:503-998-6238
Practice Address - Fax:360-326-1651
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR164936OtherPERSONAL MEDICARE
OR0000WDBCHMedicare ID - Type Unspecified