Provider Demographics
NPI:1659663417
Name:CLARKE, SHAILAGH M (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHAILAGH
Middle Name:M
Last Name:CLARKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 D ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2768
Mailing Address - Country:US
Mailing Address - Phone:503-364-6093
Mailing Address - Fax:503-364-5121
Practice Address - Street 1:2250 D ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2768
Practice Address - Country:US
Practice Address - Phone:503-364-6093
Practice Address - Fax:503-364-5121
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1838103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling