Provider Demographics
NPI:1699005009
Name:RICE, SHANNON (MA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 NE 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-8139
Mailing Address - Country:US
Mailing Address - Phone:415-730-7974
Mailing Address - Fax:
Practice Address - Street 1:4516 NE 41ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-8139
Practice Address - Country:US
Practice Address - Phone:415-730-7974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018369101YM0800X
ORC7265101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health