Provider Demographics
NPI:1992736862
Name:DEVANGE, SHANNON M (MS, CGC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:DEVANGE
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12333 NE 130TH LN
Mailing Address - Street 2:TAN 240
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7467
Mailing Address - Country:US
Mailing Address - Phone:425-899-2227
Mailing Address - Fax:425-899-2075
Practice Address - Street 1:12333 NE 130TH LN
Practice Address - Street 2:TAN 240
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7467
Practice Address - Country:US
Practice Address - Phone:425-899-2227
Practice Address - Fax:425-899-2075
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS