Provider Demographics
NPI:1902693971
Name:DUFFY, SHANNON ELSIE LEE
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELSIE LEE
Last Name:DUFFY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LEE
Other - Last Name:ARMSTRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1622 E MARINE VIEW DR APT E107
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2073
Mailing Address - Country:US
Mailing Address - Phone:509-281-1182
Mailing Address - Fax:
Practice Address - Street 1:2821 MISSION HILL RD
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-9706
Practice Address - Country:US
Practice Address - Phone:607-164-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor