Provider Demographics
NPI:1417361957
Name:CINNAMON, SHELBY SPRING
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:SPRING
Last Name:CINNAMON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHELBY
Other - Middle Name:SPRING
Other - Last Name:GREENFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:504 VILLA RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1851
Mailing Address - Country:US
Mailing Address - Phone:503-538-4874
Mailing Address - Fax:
Practice Address - Street 1:2645 PORTLAND RD NE STE 120
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0200
Practice Address - Country:US
Practice Address - Phone:503-392-5637
Practice Address - Fax:503-393-3135
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5773101YP2500X
101Y00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator