Provider Demographics
NPI:1093141889
Name:ATWILL, SHELBY (AUD)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:
Last Name:ATWILL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9521 N PORTSMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-1935
Mailing Address - Country:US
Mailing Address - Phone:503-360-6129
Mailing Address - Fax:
Practice Address - Street 1:9955 SW BEAVERTON HILLSDALE HWY STE 115
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3228
Practice Address - Country:US
Practice Address - Phone:503-567-2231
Practice Address - Fax:888-895-4828
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231HA2400X
OR030777237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500689519Medicaid