Provider Demographics
NPI:1225489834
Name:COLE, SHANNON (CRM)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16756
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0756
Mailing Address - Country:US
Mailing Address - Phone:971-386-3429
Mailing Address - Fax:503-208-2596
Practice Address - Street 1:10209 SE DIVISION ST
Practice Address - Street 2:STE D
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1372
Practice Address - Country:US
Practice Address - Phone:971-386-3429
Practice Address - Fax:503-946-8745
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13CRM040175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist