Provider Demographics
NPI:1063642759
Name:MAILHO.SHEILDS, WENDY CAROL (MS, AT, CADC3)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:CAROL
Last Name:MAILHO.SHEILDS
Suffix:
Gender:F
Credentials:MS, AT, CADC3
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1159
Mailing Address - Country:US
Mailing Address - Phone:503-258-4327
Mailing Address - Fax:503-258-0138
Practice Address - Street 1:1818 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1159
Practice Address - Country:US
Practice Address - Phone:503-258-4327
Practice Address - Fax:503-258-4682
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional