Provider Demographics
NPI:1659896314
Name:MCLAIN, SHANNON E (EDD (ABD), CESP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:E
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:EDD (ABD), CESP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 LOUISIANA ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3407
Mailing Address - Country:US
Mailing Address - Phone:360-430-6447
Mailing Address - Fax:
Practice Address - Street 1:1526 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4102
Practice Address - Country:US
Practice Address - Phone:360-749-8056
Practice Address - Fax:360-749-8060
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9358OtherCERTIFIED EMPLOYMENT SUPPORT PROFESSIONAL