Provider Demographics
NPI:1083031710
Name:SHOCKEY, KASEY
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:SHOCKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 PORTLAND RD NE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-0198
Mailing Address - Country:US
Mailing Address - Phone:503-390-5637
Mailing Address - Fax:503-393-3135
Practice Address - Street 1:2645 PORTLAND RD NE
Practice Address - Street 2:SUITE 120
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0198
Practice Address - Country:US
Practice Address - Phone:500-339-0563
Practice Address - Fax:503-393-3135
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor