Provider Demographics
NPI:1316254022
Name:DEVOLL, SHANAKO (CADC I, QMHA)
Entity type:Individual
Prefix:
First Name:SHANAKO
Middle Name:
Last Name:DEVOLL
Suffix:
Gender:F
Credentials:CADC I, QMHA
Other - Prefix:
Other - First Name:S.
Other - Middle Name:
Other - Last Name:DEVOLL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:232 NW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3609
Mailing Address - Country:US
Mailing Address - Phone:503-200-3923
Mailing Address - Fax:503-241-7419
Practice Address - Street 1:2450 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2821
Practice Address - Country:US
Practice Address - Phone:503-887-6255
Practice Address - Fax:503-212-0969
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR05-03-01101YA0400X
171M00000X
ORL7423101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator