Provider Demographics
NPI:1619670486
Name:ANDERSON, SHELLY DEE
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:DEE
Last Name:ANDERSON
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 1:1765 E THEATER LN
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-7547
Mailing Address - Country:US
Mailing Address - Phone:503-347-6691
Mailing Address - Fax:
Practice Address - Street 1:1765 E THEATER LN
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-7547
Practice Address - Country:US
Practice Address - Phone:503-347-6691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician