Provider Demographics
NPI:1386378776
Name:GODINEZ, SHYLA JANE
Entity type:Individual
Prefix:
First Name:SHYLA
Middle Name:JANE
Last Name:GODINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHYLA
Other - Middle Name:JANE
Other - Last Name:OSORIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 N MORAIN ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2667
Mailing Address - Country:US
Mailing Address - Phone:509-735-6900
Mailing Address - Fax:509-735-6914
Practice Address - Street 1:415 N MORAIN ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2667
Practice Address - Country:US
Practice Address - Phone:509-735-6900
Practice Address - Fax:509-735-6914
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61317624101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)