Provider Demographics
NPI:1427190552
Name:SHANNON, LINDA LEANN (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEANN
Last Name:SHANNON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18620 FALLS CITY RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-9498
Mailing Address - Country:US
Mailing Address - Phone:503-373-4908
Mailing Address - Fax:503-391-7422
Practice Address - Street 1:18620 FALLS CITY RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-9498
Practice Address - Country:US
Practice Address - Phone:503-373-4908
Practice Address - Fax:503-391-7422
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR38506561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical