Provider Demographics
NPI:1558513283
Name:BUDELMAN, SHANNON NICOLE (MA, MED, LMHC)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:NICOLE
Last Name:BUDELMAN
Suffix:
Gender:F
Credentials:MA, MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20126 BALLINGER WAY NE # 274
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1117
Mailing Address - Country:US
Mailing Address - Phone:206-706-2932
Mailing Address - Fax:
Practice Address - Street 1:1840 NW 202ND ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-2247
Practice Address - Country:US
Practice Address - Phone:206-706-2932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60191992101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health