Provider Demographics
NPI:1407698970
Name:REDDEN, SHANNON (CHW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:REDDEN
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:MCDOUGALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2312 NE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-8488
Mailing Address - Country:US
Mailing Address - Phone:541-460-2192
Mailing Address - Fax:
Practice Address - Street 1:6396 SW MCVEY AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-9069
Practice Address - Country:US
Practice Address - Phone:541-389-1848
Practice Address - Fax:541-550-7956
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker