Provider Demographics
NPI:1447804513
Name:HUGHES, SHANNON LEIGH
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGH
Last Name:HUGHES
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 1:1411 SW MORRISON ST STE 310
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1945
Mailing Address - Country:US
Mailing Address - Phone:503-352-2400
Mailing Address - Fax:971-266-2955
Practice Address - Street 1:1411 SW MORRISON ST STE 310
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1945
Practice Address - Country:US
Practice Address - Phone:503-352-2400
Practice Address - Fax:971-266-2955
Is Sole Proprietor?:No
Enumeration Date:2019-07-27
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program